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Palliative cancer care - nausea & vomiting - Management
What dose should I prescribe?
- Prescribe anti-emetics regularly and as required up to the maximum recommended dose.
- If the maximum recommended dose of a regular anti-emetic is reached, prescribe an alternative anti-emetic for 'as required' use.
- Table 1 shows the recommended dosing regimens for anti-emetics.
Table 1. Doses of commonly used anti-emetics.
Drug | Usual dose | Immediate/as-required dose | Syringe driver/24 hours (sc) |
|---|
Cyclizine | 25–50 mg 8 hourly (max. 150 mg/24 hours) | 25–50 mg po/sc | 50–150 mg |
Domperidone | 10–20 mg 6–8 hourly po 30–60 mg 4–8 hourly pr | — | n/a |
Haloperidol | 1.5 mg† at night and titrate up. Usual dose 3–5 mg/day (max. 10 mg/day) | 1.5 mg po 1.25–2.5 mg sc | 2.5–10 mg |
Levomepromazine | 3–6 mg* twice a day (or at night if sedation is a problem) po 6.25–12.5 mg/day sc | 3 mg po 2.5–6.25 mg sc | 5–25 mg |
Metoclopramide | 10–20 mg every 6–8 hours | 10 mg po/sc | 30–100 mg |
Hyoscine butylbromide | 20 mg every 4–6 hours po/sc | 20 mg sc | 40–120 mg |
* A 6-mg levomepromazine tablet is available on a named-patient basis (see Levomepromazine for details). † Lower starting doses of haloperidol (e.g. 0.5 mg) can be used if sedation is a problem with higher doses. po = orally; pr = rectally; sc = subcutaneously. |
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