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A Suggested Protocol for Nausea & Vomiting

Assess cause - start a vomiting diary.

If vomiting is once a day or more, give anti-emetics parenterally initially.

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Cause Site Step 1 Step 2 (if partial/no response to Step 1) Step 3 (if partial/no response to Step 2) If all else fails

DXR + raised intra cranial pressure. Anxiety Vagus-gastro-intestinal or urinary tract distension (including constipation, bowel obstruction).

Vomiting Centre

CYCLIZINE 25-50mg tds O/SC/PR

Add Haloperidol 1.5-5 mg od O/SC

Intestinal obstruction - add Octreotide 300-600 mg/24 hours


Chemotherapy Drugs (opiates) Metabolic (calcium, urea)

Toxins (including tumour load)


HALOPERIDOL 1.5mg-5mg od


Chemotherapy- substitute Ondansetron

Metabolic- add Cyclizine

Opiate induced- add Metoclopramide



- add Lorazepam

Dexamethasone 8mg od


Levomepromazine 12.5mg od

Drugs Outflow obstruction Squashed stomach (hepatomegaly, large tumour mass)

Gastric Stasis

METOCLOPRAMIDE 30-60mg O or S/C (10-20mg three times daily) or DOMPERIDONE 30-60mg PR 8 hourly


Nasogastric tube


At each step:

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© Palliative care nausea and vomiting pack 1 Dr Eileen Palmer 2008