Management

Any reversible causes should be investigated and treated if possible, this includes;

​ 1. Hypercalcaemia (treated with biphosphonates, exception in patients close to death)

 2. Raised intracranial pressure (treated with corticosteroids)

 3. Cough

 4. Drug induced (reduce or stop causative drug)

 5. Anxiety (provide psychological support)

 

Pharmacological management

The underlying cause of nausea and vomiting should be identified because this is important in the selection of treatment. However, if the cause is unknown, trial of metoclopramide, haloperidol or cyclizine is recommended for relief. It is not uncommon for more than one antiemetic to be used if multiple causative sites are responsible for emesis.

 

Drug induced vomiting (i.e. opioids) :

 

Haloperidol is the drug of choice to be used; 1.5mg adminstered one to two times daily orally, titrating up to 10mg a day.

 Acts as an antagonist at the dopamine receptors in the CTZ and prevents signals being sent to the vomiting centre.

Side effects: haloperidol can have extrapyrimadal effects such as parkinsonian like symptoms, abnormal movements, restlessness, cardiac effects such as tachycardia and arrhythmias as well as sedation. 

 

Gastric irritation:

 

Where possible stop the use of the causative drug , offer gastro protection with proton pump inhibitor such as lansoprazole 30mg or provide cyclizine 50mg taken three times daily.