Principles of managing nausea and vomiting in the last days of life

Antiemetic therapy is used for nausea and vomiting in the last days of life; follow the principles of drug therapy for symptoms in the last days of life.

The cause of nausea or vomiting in the last days of life is usually pre-existing, with continuation of the symptoms that have occurred in the preceding weeks. Although nausea and vomiting appear to lessen in the last days of life, drug therapy that has been effective to prevent these symptoms previously is usually continued if possible. For advice on adjusting existing antiemetic therapy in the last days of life, see Antiemetic therapy for nausea and vomiting in the last days of life in patients who already take an antiemetic.

Regurgitation of stomach contents is common in the last hours of life and may be confused with vomiting. Explain to the patient’s family and carers that this commonly occurs as part of the dying process.

Haloperidol or metoclopramide is usually used to treat new-onset nausea or vomiting—see Antiemetic therapy for nausea and vomiting in the last days of life in patients who do not already take an antiemetic. Haloperidol and metoclopramide both have the potential to cause extrapyramidal symptoms (eg acute dystonia); for management, see Extrapyramidal adverse effects in palliative care.

For patients with severe, complex or difficult-to-control nausea or vomiting, an alternative approach to management may be required (eg different antiemetics), seek immediate specialist palliative care advice.

For management of catastrophic terminal events, see Catastrophic terminal events in palliative care.

For general information about managing nausea and vomiting in palliative care, see Nausea and vomiting in palliative care.