Nausea Treatment Guidelines

Initial Assessment and Treatment

The National Comprehensive Cancer Network recommends evaluating patients with nausea for specific causes, including constipation, central nervous system pathology, chemotherapy, radiation therapy, hypercalcemia, medications, and gastrointestinal disorders 1, 3
The National Comprehensive Cancer Network suggests checking for medication-induced nausea by reviewing current medications, especially opioids, which commonly cause nausea 4, 2
For patients with a prior history of opioid-induced nausea, prophylactic treatment with antiemetic agents is highly recommended by the National Comprehensive Cancer Network 5, 1
The National Comprehensive Cancer Network recommends beginning treatment with dopamine receptor antagonists, such as prochlorperazine 10 mg PO every 6 hours as needed, haloperidol 0.5-1 mg PO every 6-8 hours, metoclopramide 10-20 mg PO every 6 hours, or olanzapine 2.5-5 mg PO 5, 4, 1, 6

If nausea persists despite as-needed regimen, the National Comprehensive Cancer Network recommends administering antiemetics around the clock for 1 week and then changing to as-needed dosing 1, 4
The National Comprehensive Cancer Network suggests considering adding medications with different mechanisms of action, such as serotonin (5-HT3) receptor antagonists (e.g., ondansetron 8 mg PO daily or twice daily, granisetron PO daily), anticholinergic agents (e.g., scopolamine transdermal patch 1 mg/3 days), antihistamines (e.g., meclizine), and corticosteroids (e.g., dexamethasone 2-8 mg PO or IV) 5, 1, 2, 7

The National Comprehensive Cancer Network recommends reassessing the cause and severity of nausea and considering cannabinoids (dronabinol, nabilone) for chemotherapy-induced nausea and vomiting that is refractory to standard therapies 1, 2
For opioid-induced nausea, the National Comprehensive Cancer Network suggests considering opioid rotation if nausea persists after a trial of several opioids and above measures 5, 1
Alternative therapies such as acupuncture, hypnosis, or cognitive behavioral therapy may be considered for refractory nausea by the National Comprehensive Cancer Network 2, 7

For gastritis or gastroesophageal reflux causing nausea, the National Comprehensive Cancer Network recommends using proton pump inhibitors and H2 receptor antagonists 3, 2
For gastric outlet obstruction, the National Comprehensive Cancer Network suggests considering corticosteroids, endoscopic stenting, or insertion of a decompressing G-tube 2
For patients with bowel obstruction due to cancer, the World Journal of Emergency Surgery recommends utilizing octreotide 6