Intracranial causes of nausea and vomiting in palliative care
Intracranial causes of nausea and vomiting include direct effects of tumours or raised intracranial pressure. In patients with cancer who have headache, nausea and vomiting, consider leptomeningeal disease in the differential diagnosis.
Intracranial causes of nausea and vomiting may be treated with dexamethasone; see Raised intracranial pressure in palliative care for dosages.
If dexamethasone alone does not relieve nausea and vomiting from an intracranial cause in patients with palliative care needs, add:
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
For patients with a continuous subcutaneous infusion (CSCI), use:
haloperidol 1 to 2.5 mg/24 hours by continuous subcutaneous infusion. haloperidol
Review antiemetic therapy to assess treatment response and check if the cause of the nausea has subsided. If nausea or vomiting continues despite optimal therapy, seek specialist palliative care advice.