Undifferentiated nausea and vomiting in palliative care

If the cause of nausea and vomiting is unknown, the choice and route of antiemetic drug depends on the severity of symptoms and which drugs have already been tried.

For patients with palliative care needs who have undifferentiated nonsevere nausea and vomiting, use:

1metoclopramide 10 mg orally, 8-hourly1 metoclopramide

OR

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

For patients with palliative care needs who have undifferentiated acute severe nausea and vomiting, use:

1metoclopramide 10 mg subcutaneously or intravenously, as a single dose metoclopramide

OR

1haloperidol 0.5 to 1 mg subcutaneously or intravenously, as a single dose. haloperidol

If the cause of nausea and vomiting is found, modify ongoing therapy according to the cause because this may result in faster resolution of symptomsHardy, 2018—see:

1 Metoclopramide carries a risk of irreversible tardive dyskinesia. Patients using metoclopramide for longer than 3 months have an increased risk of irreversible tardive dyskinesiaHeckroth, 2021. While recent data show this risk is lower than previously estimated, the risk of tardive dyskinesia should be consideredAl-Saffar, 2019.Return