Anti-emetics in renal disease

Cyclizine

Metabolism: Metabolised by the liver.

Dose adjustments: Avoid or use smallest dose possible in severe renal failure.

Comments: May induce hypotension and tachyarrythmia and is not recommended.

Haloperidol

Metabolism: Metabolised mainly by the liver.

Dose adjustments: Reduced doses may be required.

Comments: 1.5mg OD nocte PO/SC.

5-HT3 receptor antagonists

Metabolism: Ondansetron is metabolised mainly by the liver.

Dose adjustments: Reduced doses may be required.

Comments: Ondansetron 8mg BD PO.

Levomepromazine

Metabolism: Metabolised by the liver but excreted in the urine and faeces.

Dose adjustments: Reduced doses may be required.

Comments: 6.25mg nocte PO/SC.

Metoclopramide

Metabolism: Excreted by the kidneys.

Dose adjustments: Avoid or use smallest dose possible in severe renal failure.

Comments: Increased risk of extrapyramidal side effects in renal impairment.

DISCLAIMER

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.