- Known as Nozinan™.
- Phenothiazine anti-psychotic used for management of nausea (acting at multiple receptor sites) and can also be useful for pain and terminal restlessness.
- Starting dose = 6.25 mg – 12.5 mg PO or subcut nocte – lower doses may be effective also.
- Can either be given once daily at night or up to TDS depending on response or alternatively as a subcutaneous infusion. (Doses above 50 mg/24 hours are unusual.)
- Postural hypotension and drowsiness occur commonly and are increasingly likely at higher doses.
- Centrally acting antiemetic.
- 2 - 16 mg daily PO or via subcut or IV infusion.
- Especially useful in liver metastases, raised intracranial pressure, and chemotherapy induced nausea and vomiting.
See also: Corticosteroids
- Phenothiazine with antiemetic properties.
- 5-10 mg PO TDS - must not be given subcut.
- 3 mg buccal tabs are usually ineffective. There may be a part charge on discharge scripts.
- The rectal route (25 mg suppositories up to 8 hourly) is valuable on occasions.
- Overall has LIMITED use in palliative care.
Hyoscine (Scopoderm TTS™)
- Marked antimuscarinic effects.
- Should NOT be used concurrently with metoclopramide or domperidone.
- Apply patch to skin every 3 days (check availability).
Note: Scopoderm TTS™ patches incur a part charge at community pharmacies but if used 'in the control of intractable nausea, vomiting, or inability to swallow saliva in the treatment of malignancy or chronic disease', a special authority number can be applied for. Often there are supply problems which cause lack of availability. See PHARMAC website.
- Benzodiazepine effective for nausea exacerbated by fear/anxiety.
- The sedative side effect may often be helpful.
- 0.5 mg – 1 mg TDS PO.
The serotonin (5HT3) antagonists, e.g., ondansetron, have proven benefit in chemotherapy and radiation induced emesis BUT are NOT generally prescribed in the treatment of vomiting in Palliative Care patients due to limited evidence of benefit.
Regular ondansetron use causes significant constipation.
Topic Code: 4088