CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Palliative cancer care - nausea & vomiting - Management
How should I treat nausea and vomiting due to an abdominal or pelvic tumour?
- Nausea and vomiting because of distension, compression, or disturbance of abdominal or pelvic organs (e.g. bowel or liver): give cyclizine 25–50 mg orally every 8 hours and when required (maximum dose 150 mg/24 hours), or 75–150 mg by subcutaneous infusion over 24 hours.
- If bowel obstruction is suspected: see Managing known cause: Due to bowel obstruction.
Basis for recommendation
- These recommendations are based on specialist palliative care literature and guidelines for the management of nausea and vomiting [Regnard and Hockley, 2004; Cancer Care Alliance, 2006a].
- Vomiting commonly occurs in advanced intra-abdominal, retroperitoneal or pelvic malignancy because mechanoreceptors in the bowel wall or capsules of organs are stimulated by stretch or distortion by a tumour, stimulating the vomiting centre via the vagus and splanchnic nerves [Doyle et al, 2004].
- Anti-emetics active at the vomiting centre may therefore help to palliate nausea in this situation [Doyle et al, 2004]; cyclizine acts principally on acetylcholine and histamine type 1 (H1) receptors in the vomiting centre [Twycross et al, 2002; Mannix, 2006].
© NHS Institute for Innovation and Improvement