Nausea / Vomiting
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
If one agent is not working: don’t stop it, add another from a different class.
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.
Discussion: Nausea / Vomiting
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simple, easy and good
good to know
good to know
Je donne souvent gravol, je vais tenter de privilégier haldol, zofran, stemetil dependamment de l’indication!!
Moi aussi !
The important part that is missing to this is having the same OPQRST approach to nausea (and dyspnea etc) as pain. Then you treat accordingly. The reasons for metaclopramide being chosen over ondansetron is physiology. Ondansetron is often highly constipating and has less targets at the chemoreceptor trigger zone + bowel level. Totally agree with the above approach for palliative patients but making sure to target individually rather than blindly apply a constant
Gravol is not effective
im a zofran guy
caution with ondansetron as it can contribute to constipation (also if you discharge them on it, it is expensive and in BC not covered for pall patients unless they are on chemo)
gravol rarely effective. maxeran first, then zofran
Hard to determine N/V as a nonsurgical cause sometimes
We really under-consider the etiology of nausea when ordering meds. Gravol is very effective for vestibular issues while sedating and not effective for medication side effects for example.
hay que pensar en la polifarmacia y en la eliminación de los medicamentos pr la edad del paciente
the effects on polifarmacy, think first and review all the drugs records
pensar en la edad del paciente
Careful with medication side effects.
Ondansetron is constipating and expensive, try metaclopramide first (if sure no bowel obstruction)
I too find little use for Gravol in the geriatric setting, given its anti-chl effects and risk of falls.
gravol is on the Beers list not indicated in the elderly and not to be effective unless the patient has motion sickness
the combination of dexamethasone with a 5-HT3RA and a NK-1 receptor antagonist is the most effective regimen for acute nausea and vomiting.first generation 5-HT3RA -dolasetron,ondansetron and granisetron have equivalent efficacy. injectable palonosetron is the only drug in this class in preventing acute and delayed nausea and vomiting Haldol maybe useful in refractory n&v due to chemotherapy but less effective then metoclopramide.OLanzepine may also be useful since it antagonizes both dopamine and 5-HT receptors don`t forget nabilone!
Gravol is not effective mostly.