Nausea and vomiting are most likely because of:
- Recent treatment (e.g. chemo or radiation)
- Progression of disease (e.g bowel obstruction, ascites, hypercalcemia)
- Medications (e.g. opioids, antibiotics)
- Untreated pain
Managing Nausea and Vomiting
Dopamine antagonists are considered first-line for most cancer-associated nausea, and are also helpful for treating opioid-induced nausea:
- Metoclopramide (5-20 mg po/subcut/IV q6h)
- Haloperidol (0.5 mg iv/po)
Serotonin antagonists make a lot of sense for chemo and radiation-associated nausea. In some hospital formularies, Ondansetron 8 mg po/subcut/IV q8 – 24h is now the most cost-effective anti-emetic; still expensive for home use.
Acetyl-choline antagonists (e.g. dimenhydrinate = ©Gravol or ©Dramamine) are not especially helpful for most indications other than true vestibular causes and can be sedating and deliriumogenic in the older patient.