Management of Nausea and Vomiting

Initial Assessment

The American Society of Clinical Oncology recommends screening for nausea and vomiting at initial outpatient and inpatient visits, especially in cancer patients 2
For gastritis or gastroesophageal reflux, consider proton pump inhibitors or H2 receptor antagonists, as recommended by the Praxis Medical Insights 1

The National Comprehensive Cancer Network recommends beginning with dopamine receptor antagonists (prochlorperazine, haloperidol, metoclopramide) titrated to maximum benefit and tolerance 1, 3
For chemotherapy-induced nausea and vomiting, provide prophylaxis based on the emetogenic potential of the chemotherapy regimen, as recommended by the American Society of Clinical Oncology 2

If vomiting persists, add one or more of the following: 5-HT3 receptor antagonists (ondansetron, granisetron), anticholinergic agents, antihistamines, or cannabinoids for refractory cases, as recommended by the Praxis Medical Insights and the National Comprehensive Cancer Network 1, 3
For anxiety-related nausea, consider adding benzodiazepines (lorazepam), as recommended by the Praxis Medical Insights 1

Consider adding corticosteroids, as recommended by the Praxis Medical Insights and the National Comprehensive Cancer Network 1, 3
For intractable symptoms, continuous intravenous or subcutaneous infusion of antiemetics may be necessary, as recommended by the National Comprehensive Cancer Network 3
Consider antipsychotics such as olanzapine for persistent symptoms, as recommended by the Praxis Medical Insights and the National Comprehensive Cancer Network 1, 3
Alternative therapies like acupuncture may be beneficial in some cases, as recommended by the National Comprehensive Cancer Network 3

The American Society of Clinical Oncology recommends providing prophylaxis for acute and delayed emesis in patients receiving moderate to highly emetogenic chemotherapy 2
Follow up after treatment to assess symptom control, as recommended by the American Society of Clinical Oncology 2
For patients with small bowel obstruction, special considerations are needed, as recommended by the American Society of Clinical Oncology and the National Comprehensive Cancer Network 2, 3

Avoid antiemetics in patients with suspected mechanical bowel obstruction, as recommended by the Praxis Medical Insights 1
Monitor for extrapyramidal side effects with dopamine receptor antagonists, as recommended by the Praxis Medical Insights 1
Long-term use of benzodiazepines should be limited due to risk of dependence, as recommended by the Praxis Medical Insights 1
When using combination therapy, target different mechanisms of action for synergistic effect rather than replacing one antiemetic with another, as recommended by the Praxis Medical Insights 1