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Palliative cancer care - nausea & vomiting - Management
How should I manage nausea and vomiting of known cause?
- Manage the underlying cause or correct reversible causes if possible and appropriate.
- Try simple measures to relieve symptoms.
- Choose an anti-emetic according to the cause of nausea and vomiting:
- Ascertain the most appropriate route of administration of the anti-emetic.
- Prescribe anti-emetics regularly and as required.
- Review the effectiveness of anti-emetic treatment every 24 hours.
- Continue use of anti-emetics unless nausea and vomiting has resolved (e.g. the cause was self-limited or has been reversed).
Clarification / Additional information
- Anti-emetics vary in their affinities for the receptors involved in the causes of nausea and vomiting (see Table 1).
Table 1. Anti-emetics: receptor site affinities.
Anti-emetic | Dopamine D2 antagonist | Histamine H1 antagonist | Acetylcholine antagonist | 5-HT2 antagonist |
|---|
Metoclopramide | ++ | – | – | – |
Domperidone | ++ | – | – | – |
Cyclizine | – | ++ | ++ | – |
Hyoscine | – | – | +++ | – |
Haloperidol | +++ | – | – | – |
Levomepromazine | ++ | +++ | – | +++ |
– none or insignificant; + slight; ++ moderate; +++ marked. * Metoclopramide in higher doses >= 100 mg, demonstrates 5-HT3-receptor antagonism. |
[Twycross and Back, 1998]
Basis for recommendation
- Nausea and vomiting can be controlled in up to 70% of people in palliative care by using anti-emetics appropriate to the receptor site that is thought to contribute to nausea and vomiting [Thompson, 2004].
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