ANTI-EMETIC MEDICATION
Drug induced and biochemical cause
Haloperidol (most potent dopamine D2 receptor antagonist)
Oral: 1.5mg–3mg/24hrs
SC: 2.5mg–5mg/24hrs
Preparations:
Tablets: 500 micrograms, 1.5mg, 5mg, 10mg
Oral solution: 1mg/ml, 2mg/ml
Injection: 5mg/1 ml, 20mg/2ml
CAUTIONED USE IN EPILEPSY
AVOID IN PATIENTS WITH PARKINSON’S DISEASE & LEWY BODY DEMENTIA as has Extrapyramidal side effects (EPSEs)
Evidence of gastric stasis
Metoclopramide (dopamine D2 receptor antagonist)
Use with caution in young adults aged 15-19 (see BNF)
Oral: 10mg TDS to QDS before meals
SC: 30mg–100mg/24hrs
Preparations:
Tablets: 10mg
Oral solution: 5mg/5ml
Injection: 10mg/2ml
AVOID IN PATIENTS WITH PARKINSON’S DISEASE as can cause EPSEs
AVOID IN PATIENTS WITH COMPLETE (MECHANICAL) BOWEL OBSTRUCTION
OR Domperidone (dopamine D2 receptor antagonist; does not cross blood brain barrier so fewer side effects)
Oral: 10mg TDS
Preparations:
Tablets: 10mg
Suspension: 5mg/5ml (Maximum dose is 30mg/24 hours)
Domperidone is now contraindicated in people:
- with conditions where cardiac conduction is, or could be, impaired with underlying cardiac diseases such as congestive heart failure receiving other medications known to prolong QT interval or potent CYP3A4 inhibitors.
- with severe hepatic impairment.
If GI tract involvement or cerebral tumour, or if the above have not worked
Cyclizine
(anticholinergic antihistamine)
Oral: 50mg TDS
SC: 75mg- 100mg / 24hours
Preparations:
Tablets: 50mg
Injection: 50mg / 1ml
CAUTIONED USE IN EPILEPSY
CONTRAINDICATED IN SEVERE HEART FAILURE
Broad spectrum anti–emetic
Useful if multiple possible causes or if the above have not worked
Combine first line agents e.g. haloperidol and cyclizine
or use single broad spectrum agent
Levomepromazine
(acts at multiple receptor sites: dopamine D2, anticholinergic antihistamine)
Oral: 6mg P.R.N. (Up to 25mg/24hr)
SC: 2.5mg – 6.25mg P.R.N. (Up to 25mg/24hr)
Preparations:
Tablets: 25mg, 6mg (6mg unlicensed available on named patient basis).
Injection: 25mg/1ml
CAUTIONED USE IN EPILEPSY
USE IN PARKINSON’S DISEASE & LEWY BODY DEMENTIA
Chemotherapy and radiotherapy induced nausea and vomiting
3 day course of 5HT3 – Receptor Antagonist
For example ondansetron and granisetron
Ondansetron Oral: 8mg OD – BD
SC: up to 24mg over 24 hours
Granisetron Oral SC: 1mg–2mg per 24 hours
Preparations:
Ondansetron
Tablets and dispersible tablets: 4mg, 8mg
Syrup: 4mg/5ml
Suppositories: 16mg
Injection: 4mg/2ml, 8mg/4ml
Granisetron Tablets: 1mg, 2mg
Solution: 1mg/5ml
Injection: 1mg/1 ml,3mg/3ml
Patch: 3.1mg/24 hours
Change patch every 7 days (restrictions apply)
Contraindicated in congenital prolonged QT interval.
Serious drug interaction: a combination of IV metoclopramide and IV ondansetron occasionally causes cardia arrhythmias.
Constipation is a side effect.
Caused by moderately- to highly-emetogenic chemotherapy
Neurokinin receptor antagonists for example Aprepitant
Aprepitant: 80mg–125mg OD PO
Capsules: 80mg, 125mg