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Palliative cancer care - nausea & vomiting - Management
How should I treat drug-induced nausea and vomiting?

  • Review current medication use:
    • Discontinue use of any unnecessary medications.
    • Check blood levels if appropriate (e.g. digoxin, phenytoin, carbamazepine).
  • Chemotherapy-induced nausea and vomiting: seek advice from the specialist who is supervising the person's chemotherapy.
  • Chemically induced nausea and vomiting (most drugs, including opioids): give haloperidol, 1.5–10 mg daily:
    • Starting dosage: 1.5 mg immediately and at night.
    • Usual dosage: 3–5 mg at night or in divided doses.
    • Usual maximum dosage in nausea and vomiting: 10 mg/day (at night or in divided doses).
  • Gastrointestinal irritation (e.g. due to nonsteroidal anti-inflammatory drugs, some antibiotics, iron supplements): change the drug if possible, and consider gastroprotection.
  • Antimuscarinic drugs (e.g. amitriptyline, lofepramine, opioids): treat as for gastric stasis.
Clarification / Additional information
  • Opioids can induce nausea by several mechanisms:
    • If nausea and vomiting starts concurrently with beginning the use of an opioid, it is likely to be chemically induced.
    • If constipation is also present, nausea and vomiting may be due to gastric stasis.
  • When starting an opioid, prescribe an anti-emetic (e.g. haloperidol or metoclopramide) [Twycross et al, 2002]:
    • Regularly for the first week, to prevent opioid-induced nausea and vomiting if the person has experienced nausea with a previous opioid, or
    • On standby, for use on an as-required basis for 1 week, in case the person experiences nausea with morphine but has not experienced nausea with a previous opioid.
Basis for recommendation

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