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Palliative cancer care - nausea & vomiting - Management
How should I manage nausea and vomiting at the end of life?

  • Try simple measures to relieve symptoms.
  • If current anti-emetic controls symptoms well:
    • Continue with the same drug.
    • Give the drug by syringe driver if the person becomes unable to take oral medication. If an injectable form is not available use a drug with a similar mode of action (e.g. replace domperidone with metoclopramide, and prochlorperazine with cyclizine).
  • For new or uncontrolled nausea and vomiting:
    • If appropriate try to determine the underlying cause of nausea and vomiting and manage accordingly (see Managing known cause).
    • Otherwise give levomepromazine, 6.25 mg once daily by subcutaneous injection. Repeat the dose after 1 hour if needed.
    • If a repeat dose is needed, start levomepromazine by continuous subcutaneous injection (CSCI):
      • Start at a dose of 12.5 mg in 24 hours by CSCI, plus a 6.25 mg subcutaneous injection as needed.
      • If one or more extra doses are needed, increase the dose to 25 mg in 24 hours.
    • If symptoms remain uncontrolled, contact the local palliative care team for advice.
  • Review the effectiveness of anti-emetic treatment every 24 hours.
Clarification / Additional information
Basis for recommendation
  • This recommendation is based on UK specialist palliative care guidelines on nausea and vomiting at the end of life [Cancer Care Alliance, 2006b].

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