Management of nausea and vomiting associated with bowel obstruction in palliative care

In patients with bowel obstruction, vomiting may occur despite the patient not eating or drinking. The aim of treatment is to reduce vomiting to once every 1 or 2 days, and reduce nausea between episodes of vomiting. Tell the patient that nausea may continue to occur just before vomiting.

To manage nausea and vomiting associated with bowel obstruction in patients with palliative care needs, use:

haloperidol 0.5 to 1 mg subcutaneously, twice daily, and 0.5 to 1 mg 4-hourly as required. Maximum dose 5 mg daily. haloperidol

For patients with a continuous subcutaneous infusion (CSCI), use:

haloperidol 1 to 2.5 mg/24 hours by continuous subcutaneous infusion. haloperidol

Prokinetic drugs (eg metoclopramide, domperidone, senna, bisacodyl) may worsen pain in patients with bowel obstruction and should be used with caution.

Octreotide may be considered for patients with vomiting that persists despite haloperidol therapy if bowel obstruction is not reversible—seek specialist palliative care adviceCurrow, 2015 Davis, 2021.

If nausea and vomiting remain uncontrollable, other antiemetics (eg cyclizine, levomepromazine) may be used—seek specialist advice.

If large-volume vomiting remains a problem, or frankly feculent vomiting occurs, consider placing a nasogastric tube. A venting gastrostomy can also provide significant relief—seek specialist palliative care advice.