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Antiemetics in palliative care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • review medication and if possible stop or reduce drugs likely to cause nausea

  • treat any identifiable cause
    • causes to consider:
      • abnormal biochemistry (e.g. hypercalcaemia, uraemia or hyponatremia) - treat where appropriate
      • drugs (e.g. opioids, bisphosphonates, metronidazole, anticonvulsants) - anti-emetics may be necessary for a few days when opioid treatment is initiated. Not all patients require this
      • avoid drugs with anticholinergic effects in patients with gastric stasis (e.g. hyoscine, antidepressants, cyclizine)
      • constipation - Prevent and treat aggressively
      • gastritis - use a proton pump inhibitor e.g. lansoprazole
      • chemotherapy induced nausea & vomiting - a short course of 5HT 3 -receptor antagonists may be appropriate
      • raised intracranial pressure
      • anxiety: psychological care with or without benzodiazepines
      • oropharyngeal thrush: a course of antifungal treatment

  • give regular anti-emetic if the patient is nauseated

  • tailor treatment to the severity and frequency of symptoms:
    • for mild nausea and vomiting (less than once a day), give oral medication
    • for moderate nausea and vomiting (more than once a day) give s.c. or rectal medication
    • for severe or continuous nausea and vomiting, give s.c. medication via a syringe driver

  • different regimens may be used where nausea & vomiting is due to:
    • gastric stasis or gastritis
    • bowel obstruction
    • morphine, toxic or metabolic effects
    • raised intracranial pressure
    • anxiety or sensory stimuli
    • chemotherapy

A step by step approach to management of nausea and vomiting is linked in the menu below.

Reference:

  1. Dr Michael Cushen, St Elizabeth Hospice, Ipswich 5/96
  2. West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptom control.
  3. West Midlands Palliative Care Physicians (2012). Palliative care - guidelines for the use of drugs in symptom control.

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