A management approach should be based upon the clinically determined mechanism of nausea and/or vomiting, which can be multifactorial.
The pressure from ascitic fluid may cause gastric compression. The patient may benefit from treatment of ascites alongside a pro-kinetic anti-emetic such as metoclopramide.
Nausea may be secondary to accumulation of toxins and therefore centrally acting anti-emetics, such as haloperidol, may be indicated.
Upper gastro-intestinal bleeding due to portal hypertension may damage enterochromaffin cells, leading to release of the neuro-transmitter serotonin (5HT3) which can cause vomiting. 5HT3 antagonists, such as ondansetron and granisetron, could be tried.
Cyclizine and levomepromazine can also be tried as they are broad-spectrum anti-emetics.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.