Prescribing guidance for nausea and vomiting

Antiemetic naïve

1. Prescribe an antiemetic. Consider:
   • metoclopramide - 10mg SC PRN three times a day (PBS)
     OR
   • haloperidol - 0.5mg to 1.5mg SC PRN twice a day (PBS)
    
2. Administer PRN antiemetic
3. Assess effectiveness of administered medicine and continue administering as required
4. Observe closely for extrapyramidal side effects (e.g. akathisia)

Antiemetic tolerant

1. Review current antiemetic and dose:
   • If the patient is unable to swallow, consider conversion to CSCI using a syringe driver over 24 hours
   • Ensure order written for antiemetic dose PRN
2. Administer PRN antiemetic dose
3. Assess effectiveness of administered medicine and continue administering antiemetic as required
4. Observe closely for extrapyramidal side effects of metoclopramide / haloperidol (e.g. akathisia)

 

Prescribing considerations

• Review patient regularly
• If greater than 3 doses of PRN metoclopramide 10mg SC are required over 24 hour period, or if prescribed haloperidol dose ineffective over 24 hour period, review and consider changes in medication and syringe driver orders
• Check availability of medicines through the patient’s usual pharmacy

The medicines listed throughout this app are in line with those endorsed by Caring at Home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM) within the Community End-of-Life Medicines List (168kb pdf).