Managing Nausea and Vomiting in Palliative Care

Nausea is unfortunately a very common symptom in palliative care patients. It’s a frequent complaint in cancer patients, but can also affect patients with kidney failure and heart disease. Understanding the causes of nausea and vomiting in palliative care patients is an important step to finding a treatment that will help improve their quality of life.

Causes of Nausea and Vomiting in Palliative Care Patients

There are a number of things that can cause nausea and vomiting. Nausea can be a side effect of some medication, certain treatments, and the disease the patient is facing. Unpleasant smells and tastes can trigger nausea. Pain medications, NSAIDS, antibiotics, and chemotherapy can also cause nausea and vomiting.

Constipation and bowel obstructions can also cause nausea and vomiting in palliative care patients.

Treatment for Nausea and Vomiting in Palliative Care Patients

Where possible, removing the cause of nausea in palliative care patients is the best possible treatment. This can include treating constipation, discontinuing certain medication, and avoiding unpleasant smells.

When removing the cause is not possible, medication can be an effective treatment. Depending on the cause of the nausea, potential drug interactions and side effects, and the patient’s condition, some of the medication that may be prescribed include:

Ativan (Lorazepam) binds to gamma-aminobutyric acid (GABA) receptors in the brain, producing a calming effect and lowering anxiety which can increase nausea and vomiting symptoms.

Benadryl (Diphenhydramine) is commonly known as an antihistamine, but it can also be used to treat nausea, especially when caused by motion sickness. Antihistamines can dull the inner ear’s sense of motion, blocking the messages to the brain that control nausea and vomiting.

Compazine (Prochlorperazine) blocks dopamine receptors in the brain that are responsible for nausea and vomiting. This can counteract the dopamine released during chemotherapy treatments that often triggers vomiting.

Haloperidol (Haldol) also works by blocking dopamine receptors. It is most commonly used to treat terminal delirium and agitation in end-stage dementia, but it is also effective in managing nausea and vomiting.

Phenergan (Promethazine) is designed to block histamine released in chemotherapy treatments from binding to histamine (H1) receptors in the brain. Phenergan binds to the H1 receptors instead, which reduces the need to vomit. It is also effective in stopping nausea caused by postoperative pain.

Reglan (Metoclopramide) is used to treat heartburn and ulcers in patients with gastroesophageal reflux disease (GERD). It can also help diabetic patients and postoperative patients suffering from gastroparesis (poor emptying of the stomach) by increasing muscle contractions in the upper digestive tract which speeds up movement in the stomach and intestines.

Depending on the patient’s ability to keep medication down, the medications above may be administered in a variety of ways including pills, liquid doses, suppositories, or a topical gel.

Other Treatments for Nausea in Palliative Care Patients

If medication is not available or the patient is waiting for it to arrive, there are other ways to help reduce the feeling of nausea:

• Loosen clothing and open windows for fresh air.
• Apply a cool, wet towel to the forehead, neck, and wrists.
• Avoid odors that cause nausea. This includes perfume, after-shave, scented candles, air fresheners, and essential oils.
• Serve food cold or at room temperature to reduce odors. Avoid cooking food that produces strong odors.
• Limit food intake to small meals and don’t serve beverages with meals. Liquids should be consumed throughout the day, but avoid drinking too much liquid while eating food.

Crossroads Hospice & Palliative Care assigns a team of healthcare professionals to work with patients experiencing nausea and vomiting caused by a serious illness or as a side effect of cancer treatment. Call 1-888-564-3405 to learn more about what is palliative care treatment and how it can help.

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