Nausea and vomiting in palliative care
Finding the cause of nausea in advanced illness, matching the antiemetic to the likely mechanism, the doses and routes used in palliative care, malignant bowel obstruction, and the drug interactions that undo each other.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Nausea affects up to 60% of people with advanced cancer, and is common in end-stage heart, renal and liver failure. It is often worse for patients than vomiting.
- Look for the cause first. Many causes are reversible: constipation, drugs, hypercalcaemia, infection, bowel obstruction, raised intracranial pressure.
- Choose the antiemetic by the most likely mechanism, give it regularly (not as needed), and by a non-oral route if the patient is vomiting.
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Sources
- Therapeutic Guidelines: Palliative Care (eTG complete), version 5AU/NZTherapeutic Guidelines Limited, 2024 (version 5, December 2024)
- Davis M et al. MASCC antiemetics in advanced cancer updated guideline. Support Care Cancer 2021;29:8097-8107Multinational Association of Supportive Care in Cancer, 2021 (current at November 2026)
- Herrstedt J et al. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open 2024;9:102195MASCC and ESMO, 2023
- Hardy JR et al. Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial. BMJ Open 2019;9:e029942BMJ Open, 2019
- Navari RM et al. Olanzapine for the treatment of advanced cancer-related chronic nausea and/or vomiting: a randomized pilot trial. JAMA Oncol 2020;6:895-899JAMA Oncology, 2020
- Currow DC et al. Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction. J Pain Symptom Manage 2015;49:814-821AU/NZJournal of Pain and Symptom Management, 2015
- Metoclopramide-containing medicines (Article 31 referral)European Medicines Agency, 2013
- Medicines Safety Update 2015;6(1): metoclopramide and risk of neurological adverse effectsAU/NZTherapeutic Goods Administration (via Australian Prescriber), 2015
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy