Central causes of nausea and vomiting in palliative care
Drugs or metabolic dysfunction (eg hypercalcaemia, uraemia) may affect the central nervous system and cause nausea. The nausea is commonly characterised as becoming worse with the smell or sight of food, with occasional dry retching.
For management of nausea and vomiting from central causes in patients with palliative care needs, use:
1haloperidol 0.5 to 1 mg orally, twice daily, and 0.5 to 1 mg 4-hourly as required. Maximum dose 5 mg daily haloperidol
OR
1haloperidol 0.5 to 1 mg subcutaneously, twice daily, and 0.5 to 1 mg 4-hourly as required. Maximum dose 5 mg daily haloperidol
OR
1metoclopramide 10 mg orally, 8-hourly1 metoclopramide
OR
2prochlorperazine 5 to 10 mg orally, 6- to 8-hourly. prochlorperazine
For patients with a continuous subcutaneous infusion (CSCI), use:
1haloperidol 1 to 2.5 mg/24 hours by continuous subcutaneous infusion haloperidol
OR
1metoclopramide 30 mg/24 hours by continuous subcutaneous infusion1. metoclopramide
Haloperidol, metoclopramide and prochlorperazine have similar modes of action. Prochlorperazine appears to have a higher incidence of adverse effects when given in typical doses, and cannot be given subcutaneously.
Review antiemetic therapy to assess treatment response and check if the cause of the nausea has subsided. If initial therapy was not effective, switch to another drug. If nausea or vomiting continues despite optimal therapy, seek specialist palliative care advice.