Chemotherapy- and radiotherapy-induced nausea and vomiting in palliative care
Nausea and vomiting associated with chemotherapy or radiotherapy often respond to a 5-HT3–receptor antagonist in combination with dexamethasone. Dexamethasone and 5-HT3–receptor antagonists are often part of chemotherapy or radiotherapy treatment regimens—to avoid confusion, check with the prescriber before making any changes to the treatment regimen.
For nausea and vomiting associated with chemotherapy or radiotherapy, use:
a 5-HT3–receptor antagonist, orally for up to 5 days; for example:
ondansetron 4 to 8 mg orally, 8- to 12-hourly1 ondansetron
PLUS
dexamethasone 4 mg orally, daily. Assess within 2 to 3 days and stop if there is no benefit. If there is benefit, reduce to the lowest effective dose and use for the shortest possible time. For advice on stopping dexamethasone, see Rationalising corticosteroids used for symptom or complication management in palliative care. dexamethasone
For parenteral dosing of ondansetron, see Nausea and vomiting in the last days of life.
Be aware of the constipating effects of the 5-HT3–receptor antagonists; anticipatory prescribing of laxatives may be required (see Prevention of constipation in palliative care).
Review antiemetic therapy to assess treatment response. There are other therapeutic options to manage chemotherapy-induced nausea and vomiting; seek specialist palliative care advice.