- Tumour-Related Nausea (not chemotherapy related)

Tumour-Related Nausea (not chemotherapy related)

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Posted Thursday 27 September 2007 - 15:20 PM by Deborah Chan

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Condition*

First Line Drugs

Choice 1*

ATC Code (read only) Choice 2

ATC Code (read only) Choice 3

ATC Code (read only)

Second Line Drugs

Choice 1

ATC Code (read only) Choice 2

ATC Code (read only) Choice 3

ATC Code (read only)

For Pregnant Women, Suggest:

Choice 1

ATC Code (read only) Choice 2

ATC Code (read only) Choice 3

ATC Code (read only) Comments/Instructions

1. Metabolic (hypercalcemia, liver failure or uremia)

haloperidol
0.5-5 mg, once daily to bid
$0.04-0.30/day

or
0.5-5 mg SC, once daily to bid
$0.33-3.32/day

or prochlorperazine
5-10 mg, qid
$0.42-0.52/day

or
5-10 mg SC or IM, qid
$2.84-5.68/day

or
10 mg per rectum, qid
$3.32/day

2. Raised intracranial pressure

promethazine
25 mg, qid
$0.59/day

or
25 mg IM, qid
$2.44/day

or dexamethasone
4-8 mg, bid
$2.44-4.87/day

3. Gastric stasis associated with either opioid analgesics or physical obstruction to gastric outflow

metoclopramide
10-20 mg qid (ac and hs)
$0.23-0.47/day

or
10-20 mg SC or IM, qid(ac and hs)
$5.92-11.84/day

or domperidone
10-20 mg, qid (ac and hs)
$0.71-1.42/day

or cisapride
5-10 mg, qid (ac and hs)
$1.14-2.22/day

or dexamethasone
4-8 mg, bid
$2.44-4.87/day

4. Malignant intestinal obstruction

haloperidol
0.5-5 mg, once daily to bid
$0.04-0.30/day

or
0.5-5 mg IM, once daily to bid
$0.33-6.64/day

or loperamide
4-8 mg, every 4 h for the first 24 h; then every 4 h prn
$2.96-5.93/day

or octreotide
50-100 µg SC, bid to tid
$10.94-30.93/day

5. Narcotic induced

haloperidol
0.5-5 mg, once daily to bid
$0.04-0.30/day

or
0.5-5 mg IM, once daily to bid
$0.33-6.64/day

or metoclopramide
10-20 mg, qid (ac and hs)
$0.23-0.47/day

or
10-20 mg SC or IM, qid(ac and hs)
$5.92-11.84/day

or prochlorperazine
5-10 mg, qid
$0.42-0.52/day

or
5-10 mg IM, qid
$2.84-5.68/day

or
10 mg per rectum, qid
$3.32/day

6. Associated with movement or vertigo, see Motion sickness

Additional instructions and notes

-For most patients on strong opioids, antiemetics should be given regularly (not prn) and prophylactically unless there has been no nausea with previous opioid use.

-Parenteral or transcutaneous preparations should be used when patients are vomiting or unable to absorb oral medications.

-In cases of undifferentiated nausea, metoclopramide can be used alone or combined with dexamethasone.

Reference

First Line Drugs

APO HALOPERIDOL TAB 0.5MG (N05AD01)

APO-DEXAMETHASONE 4MG (H02AB02)

METOCLOPRAMIDE TAB 10MG (A03FA01)

Reference

http://oscarmcmaster.org:25300/oscarResource-Pl...

Comments/Instructions

1. Metabolic (hypercalcemia, liver failure or uremia)

haloperidol
0.5-5 mg, once daily to bid
$0.04-0.30/day

or
0.5-5 mg SC, once daily to bid
$0.33-3.32/day

or prochlorperazine
5-10 mg, qid
$0.42-0.52/day

or
5-10 mg SC or IM, qid
$2.84-5.68/day

or
10 mg per rectum, qid
$3.32/day

2. Raised intracranial pressure

promethazine
25 mg, qid
$0.59/day

or
25 mg IM, qid
$2.44/day

or dexamethasone
4-8 mg, bid
$2.44-4.87/day

3. Gastric stasis associated with either opioid analgesics or physical obstruction to gastric outflow

metoclopramide
10-20 mg qid (ac and hs)
$0.23-0.47/day

or
10-20 mg SC or IM, qid(ac and hs)
$5.92-11.84/day

or domperidone
10-20 mg, qid (ac and hs)
$0.71-1.42/day

or cisapride
5-10 mg, qid (ac and hs)
$1.14-2.22/day

or dexamethasone
4-8 mg, bid
$2.44-4.87/day

4. Malignant intestinal obstruction

haloperidol
0.5-5 mg, once daily to bid
$0.04-0.30/day

or
0.5-5 mg IM, once daily to bid
$0.33-6.64/day

or loperamide
4-8 mg, every 4 h for the first 24 h; then every 4 h prn
$2.96-5.93/day

or octreotide
50-100 µg SC, bid to tid
$10.94-30.93/day

5. Narcotic induced

haloperidol
0.5-5 mg, once daily to bid
$0.04-0.30/day

or
0.5-5 mg IM, once daily to bid
$0.33-6.64/day

or metoclopramide
10-20 mg, qid (ac and hs)
$0.23-0.47/day

or
10-20 mg SC or IM, qid(ac and hs)
$5.92-11.84/day

or prochlorperazine
5-10 mg, qid
$0.42-0.52/day

or
5-10 mg IM, qid
$2.84-5.68/day

or
10 mg per rectum, qid
$3.32/day

6. Associated with movement or vertigo, see Motion sickness

Additional instructions and notes

-For most patients on strong opioids, antiemetics should be given regularly (not prn) and prophylactically unless there has been no nausea with previous opioid use.

-Parenteral or transcutaneous preparations should be used when patients are vomiting or unable to absorb oral medications.

-In cases of undifferentiated nausea, metoclopramide can be used alone or combined with dexamethasone.