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Table 1 Clinical practice guidelines for the management of nausea

From: A randomized open-label study of guideline-driven antiemetic therapy versus single agent antiemetic therapy in patients with advanced cancer and nausea not related to anticancer treatment

Dominant cause Treatment Step 1 Treatment Step 2 Treatment Step 3
A: Central/chemoreceptor trigger zone (CTZ) stimulation Prochlorperazine 5 mg tds po or 25 mg PR then 5 mg tds po or 12.5 mg bd IM/iv Haloperidol 1.5 mg/24 h po or sc Haloperidol 3 mg/24 h po or sc
B: Central nervous system (CNS) disease Dexamethasone 8 mg/24 h po/sc/iv Dexamethasone 12 mg/24 h po/sc/iv Dexamethasone 16 mg/24 h po/sc/iv
C: Vestibular involvement Prochlorperazine 5 mg tds po or 25 mg PR then 5 mg tds po or 12.5 mg bd IM/iv Prochlorperazine 10 mg tds po or 25 mg PR then 10 mg tds po or 12.5 mg tds IM/iv Promethazine 25 mg tds po or 12.5 mg sc then 10 mg tds po
D: Gastric stasis Metoclopramide 10 mg qid po/sc/iv Metoclopramide 10 mg Q4h po/sc/iv Metoclopramide 10 mg Q4h po/sc/iv
Dexamethasone 8 mg/24 h po/sc/iv
E: Ileus Metoclopramide 10 mg qid po/sc/iv Metoclopramide 10 mg Q4h po/sc/iv Metoclopramide 10 mg Q4h po/sc/iv
Dexamethasone 8 mg/24 h po/sc/iv
F: Mechanical obstruction Haloperidol 1.5 mg/24 h po/sc
Dexamethasone 8 mg/24 h po/sc/v
Haloperidol 3 mg/24 h po/sc
Dexamethasone 8 mg/24 h po/sc/iv
Haloperidol 3 mg/24 h po/sc
Dexamethasone 8 mg/24 h po/sc/iv
Hyoscine butylbromide 80 mg/24 h sc or Ranitidine 200 mg/24 h sc
G: Gastritis Metoclopramide 10 mg qid po/sc/iv
PPI min dose
Metoclopramide 10 mg qid po/sc/iv
PPI max dose
Metoclopramide 10 mg Q4h po/sc/iv
PPI max dose
H: Cause undetermined (or multifactorial) Metoclopramide 10 mg qid po/sc/iv Metoclopramide 10 mg qid po/sc/iv
Haloperidol 1.5 mg/24 h po/sc
Metoclopramide 10 mg Q4h po/sc/iv
Haloperidol 3 mg/24 h po/sc
  1. Po by mouth, PR per rectum, sc subcutaneous, iv intravenous, IM intramuscular, bd twice daily, tds three times daily, qid four times daily, Q4h four hourly, PPI proton pump inhibitor, Min minimum, Max maximum