Anti-emetic ladder
General Rules
- Look for/treat reversible causes (see below).
- Reassess causes at each step.
- Start iv/im (and switch to po ASAP).
- Consider sc pump if chronic.
- Don't stop Rx unless cause removed.
5
- Designed for cancer patients where refactory nausea common. Steps 3 and 4 rarely necessary in other settings.
4
- ↑Levomepromazine.
- Consider octreotide or dexamethazone.
3
- Try levomepromazine or a 5HT3 antagonist (e.g. ondansetron).
2
- Try alternative or add 2nd narrow-spectrum agent.
- Consider dexamethasone if cause is brain tumour (or other cause of ↑ICP) or chemotherapy
1
- Start narrow/spectrum drug
