Treating nausea and vomiting in palliative care: A review Journal Article


Authors: Glare, P.; Miller, J.; Nikolova, T.; Tickoo, R.
Article Title: Treating nausea and vomiting in palliative care: A review
Abstract: Nausea and vomiting are portrayed in the specialist palliative care literature as common and distressing symptoms affecting the majority of patients with advanced cancer and other life-limiting illnesses. However, recent surveys indicate that these symptoms may be less common and bothersome than has previously been reported. The standard palliative care approach to the assessment and treatment of nausea and vomiting is based on determining the cause and then relating this back to the "emetic pathway" before prescribing drugs such as dopamine antagonists, antihistamines, and anticholinergic agents which block neurotransmitters at different sites along the pathway. However, the evidence base for the effectiveness of this approach is meager, and may be in part because relevance of the neuropharmacology of the emetic pathway to palliative care patients is limited. Many palliative care patients are over the age of 65 years, making these agents difficult to use. Greater awareness of drug interactions and QTc prolongation are emerging concerns for all age groups. The selective serotonin receptor antagonists are the safest antiemetics, but are not used first-line in many countries because there is very little scientific rationale or clinical evidence to support their use outside the licensed indications. Cannabinoids may have an increasing role. Advances in interventional gastroenterology are increasing the options for nonpharmacological management. Despite these emerging issues, the approach to nausea and vomiting developed within palliative medicine over the past 40 years remains relevant. It advocates careful clinical evaluation of the symptom and the person suffering it, and an understanding of the clinical pharmacology of medicines that are available for palliating them. © 2011 Glare et al, publisher and licensee Dove Medical Press Ltd.
Keywords: clinical feature; constipation; drowsiness; fatigue; neutropenia; review; percutaneous endoscopic gastrostomy; placebo; diarrhea; drug dose reduction; drug withdrawal; liver function; side effect; skin manifestation; drug megadose; palliative care; disease association; unindexed drug; edema; gastrointestinal symptom; nausea; vomiting; chlorpromazine; haloperidol; olanzapine; extrapyramidal symptom; orthostatic hypotension; palliative therapy; prevalence; qt prolongation; sedation; bedtime dosage; dexamethasone; bradycardia; kidney failure; patient assessment; continuous infusion; dizziness; drug fever; hyperglycemia; chemotherapy induced emesis; confusion; drug induced headache; hypotension; drug antagonism; drug mechanism; tramadol; cardiotoxicity; dementia; comorbidity; xerostomia; benzodiazepine derivative; granisetron; ondansetron; anxiety disorder; nausea and vomiting; insulin; sepsis; injection site pain; drug toxicity; octreotide; antiemetics; seizure; motion sickness; drug bioavailability; time to maximum plasma concentration; vestibular disorder; leukocyte count; intestine obstruction; drug dose titration; drug half life; respiration depression; somnolence; hypothyroidism; corticosteroid; disease control; dyspepsia; behavior therapy; hallucination; urine retention; metoclopramide; gastrointestinal disease; gallstone; abdominal cramp; levomepromazine; prochlorperazine; geriatric patient; creatinine clearance; antihistaminic agent; serotonin 3 antagonist; erythromycin; avoidance behavior; weight gain; heart rate; cannabinoid; increased appetite; intracranial hypertension; dolasetron mesilate; palonosetron; dystonia; serotonin 5-ht3 receptor antagonists; qt interval; dopamine receptor blocking agent; prokinetic agent; promethazine; scopolamine bromide; scopolamine butyl bromide; injection site burning; injection site stinging; restlessness; phenothiazine derivative; piperazine; scopolamine; anticholinergic effect; cancer associated dyspepsia syndrome; postoperative nausea and vomiting; seizure threshold; dopamine antagonists; histamine antagonists
Journal Title: Clinical Interventions in Aging
Volume: 6
Issue: 1
ISSN: 1176-9092
Publisher: Dove Medical Press Ltd  
Date Published: 2011-01-01
Start Page: 243
End Page: 259
Language: English
PROVIDER: scopus
PMCID: PMC3180521
PUBMED: 21966219
DOI: 10.2147/CIA.S13109
DOI/URL:
Notes: --- - "Export Date: 9 December 2011" - "Source: Scopus"
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MSK Authors
  1. Roma Tickoo
    14 Tickoo
  2. Paul A Glare
    46 Glare
  3. Jeanna A Miller
    3 Miller