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Palliative cancer care - nausea & vomiting - Management
What route of administration should I use?

  • Oral administration is the route of choice. However, this may not be appropriate for people:
    • Who cannot swallow.
    • With compromised absorption.
    • Who have persistent nausea and vomiting.
    • In whom swallowing causes them to vomit.
    • With gastric stasis or bowel obstruction.
  • If the oral route is not appropriate, give anti-emetics parenterally (subcutaneously or intravenously) or rectally. The intramuscular route is not recommended as patients tend to be cachectic.
  • If the person has continuous or severe nausea or frequent vomiting, continuous subcutaneous infusion via a syringe driver is the route of choice.
Clarification / Additional information
  • Continuous subcutaneous infusion (via a syringe driver) is used for drug delivery if the person cannot take medicines by mouth (e.g. because of persistent nausea and vomiting, dysphagia, severe weakness, poor oral absorption, or coma).
  • Use only drugs that are known to be safe and effective by the subcutaneous route. These include metoclopramide, haloperidol, cyclizine, hyoscine butylbromide, and levomepromazine.
  • Use water for injection as the diluent when mixing drugs in a syringe driver (except for octreotide).
  • Use sodium chloride as the diluent for octreotide and consider a second syringe driver if octreotide is to be co-administered with other drugs.
  • Check the compatibility of drugs before mixing. Most data concern combinations of two drugs in a syringe driver, although some combinations of three or four drugs are compatible. For further information on the compatibility of drugs in syringe drivers, seek advice from the local palliative care team or hospital drug information service. If you cannot contact them, see www.palliativedrugs.com.
  • Do not use solutions that are discoloured or have precipitated.

[Twycross and Wilcock, 2001; Fife Area Drug & Therapeutics Committee, 2004; Perdue, 2005]

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