1) First line - single agent based on underlying cause. Use regularly and to maximum dose before changing. If one drug is ineffective then use an alternative first line agent.
Cause of Nausea | Suggested Drug | Dose and Route |
Drug induced and biochemical | haloperidol | oral: 1.5-3mg od - bd s.c. 2.5-5mg/24hr |
Evidence of gastric stasis | metoclopramide
| oral: 10-20mg tds before meals s.c. 30-100mg/24hr |
OR domperidone (does not cross the blood brain barrier so fewer side effects) | oral: 10mg tds p.r. 30mg bd or tds | |
If GI tract involvement or cerebral turmour, or if the above have not worked | cyclizine | oral: 50mg tds s.c. 150mg/24hr |
2) Second line - add another first line age (e.g. cyclizine and haloperidol) or change to 'broad spectrum' agent
Cause of Nausea | Suggested Drug | Dose and Route |
Broad spectrum anti-emetic useful if multiple possible causes | levomepromazine (acts at multiple receptor sites) | oral: 6mg-25mg nocte s.c. 6.25-25mg/24h
|
3) Third line - if other drugs are not controlling symptoms try
Suggested drug | Dose and Route |
3 day course of 5HT3-receptor antagonist e.g. ondansetron, granisetron or tropisetron | ondansetron - oral: 8mg bd; s.c. up to 24mg per 24 hrs granisetron - oral/s.c. 1-2mg per 24hrs
|
Nausea and vomiting caused by moderately- to highly- emetogenic chemotherapy
| Aprepitant 80mg- 125mg OD PO Capsules: 80mg, 125mg |
Raised intracranial pressure or intractable nausea and vomiting
|
Notes:
The respective summary of product characteristics must be consulted before prescribing any of the drugs detailed.
Reference:
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