Assessment

Accurate diagnosis of the aetiology of both nausea and vomiting as separate symptoms is important; reversal of any cause is preferential to simply treating the symptom and should include a review of medication. Consider the possibility of withdrawing any causative agent from the patient’s drug profile.

Treatment

Base selection of an antiemetic on the likely cause, mechanism of action of the drugs available, the side-effect profile of each drug, interactions and concomitant conditions. Refer to guidance below and/or to BNF:

• Antiemetic selection
• Antiemetics used in palliative care
• Raigmore Hospital guidance on Surgical Ward Management of Post Operative Nausea and Vomiting in Adults.

Use metoclopramide and prochlorperazine with caution in the young, the very old and the debilitated, due to extrapyramidal side-effects. Domperidone does not readily cross the blood-brain barrier and is less likely to exhibit these side-effects. See Analgesics for the use of antiemetics in the treatment of migraine.