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Palliative cancer care - nausea & vomiting - Management
How should I manage nausea and vomiting of unknown cause?
- Try simple measures to relieve symptoms.
- Review the history, examination, and medication and consider further investigations if appropriate.
- If the cause is still uncertain or further investigation is not appropriate:
- Try 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: 10 mg/day (at night or in divided doses).
- Add cyclizine (25–50 mg three times a day) if haloperidol alone is not effective.
- If still ineffective, change to levomepromazine or consider a trial of dexamethasone (seek specialist advice first).
- 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 anti-emetics unless nausea and vomiting has resolved.
In depth
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