Palliative care: Nausea and vomiting
As with pain, there are many causes of nausea and vomiting (e.g. constipation, severe pain, hypercalcaemia, intestinal obstruction, drugs). It is important to identify the most likely cause as this determines the treatment.Antiemetics can be categorised according to their pharmacological group, effect on a specific neurotransmitter, or likely site of action.
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The oral route is suitable for prophylaxis where there is mild nausea and vomiting; non-oral routes should be used for moderate to severe symptoms.
In practice cyclizine, haloperidol or a prokinetic such as metoclopramide or domperidone are often used as first-line antiemetics. Levomepromazine is also used as an antiemetic in palliative care. You do need to be careful about the contraindications to each antiemetic, and assess their relevance to the individual patient.