Management of Nausea

Assessment and Identification of Cause

The primary goals of care for managing nausea should focus on adequate symptom control, reduction of patient distress, acceptable sense of control, relief of caregiver burden, strengthened relationships, optimized quality of life, and personal growth and enhanced meaning, as recommended by the National Comprehensive Cancer Network 1
Initial evaluation should identify specific causes of nausea, including medication-induced, psychogenic, gastrointestinal disorders, and disease-specific causes, although the American College of Physicians may have varying recommendations 2
Check available blood levels of medications that may cause nausea, such as digoxin, phenytoin, carbamazepine, and tricyclic antidepressants, as suggested by the National Comprehensive Cancer Network and the American College of Clinical Pharmacy 1, 2

Initiate pharmacologic management with dopamine receptor antagonists, such as haloperidol, metoclopramide, and prochlorperazine, for non-specific nausea and vomiting, as recommended by the National Comprehensive Cancer Network 1
The American Society of Clinical Oncology recommends using 5-HT3 receptor antagonists, such as ondansetron, as effective first-line treatments for nausea and vomiting 3, 4
Granisetron offers similar efficacy to ondansetron with different administration options, according to the American College of Clinical Pharmacy 3, 4

Eat small, frequent meals rather than large meals, and choose foods at room temperature rather than hot foods, as suggested by the American Cancer Society 2, 3
Ensure adequate hydration throughout the day, and consider dietary consultation for persistent nausea, as recommended by the Academy of Nutrition and Dietetics 2, 3

For high emetic risk chemotherapy, use a four-drug combination of a neurokinin 1 receptor antagonist, a 5-HT3 receptor antagonist, dexamethasone, and olanzapine, as recommended by the American Society of Clinical Oncology 5
For gastroparesis-related nausea, metoclopramide is recommended, according to the American Gastroenterological Association 1, 7