Chronic nausea in advanced cancer patients: A retrospective assessment of a metoclopramide-based antiemetic regimen

Abstract

The purpose of this retrospective study is to assess the frequency and intensity of chronic nausea in patients admitted to the Palliative Care Unit and the results of a metoclopramide-based treatment regimen. We reviewed the medical records of 100 consecutive patients admitted to the Palliative Care Unit at the Edmonton General Hospital until death during 1992-1993. All patients had terminal cancer and normal cognitive function. All patients completed the Functional Analogue Scale for appetite, nausea, pain, activity, shortness of breath, and sensation of well-being at 1000 and 1600 hours every day. Patients who complained of nausea initially received metoclopramide 10 mg every 4 hr orally or subcutaneously (Step 1). If nausea persisted, dexamethasone 10 mg twice daily was added (Step 2). Step 3 consisted of a continuous subcutaneous infusion of metoclopramide of 60-120 mg/day plus dexamethasone. If no response was observed, other antiemetics were administered (Step 4). Upon admission to the unit, 32 patients (32%) presented with nausea. During the average admission of 25 +/- 13 days, 98 patients (98%) developed nausea. Twenty-five patients (25%) required other antiemetics because of bowel obstruction (18), extrapyramidal side effects (3), or other reasons (4). Most patients without bowel obstruction achieved excellent control of nausea using the metoclopramide-based regimen. During the first 5 days and last 5 days of admission, nausea had significantly lower intensity than the rest of the symptoms that were monitored. Our results suggest that, although nausea is very frequent, it can be well controlled in the majority of patients using safe and simple antiemetic regimens.

Multidisciplinary symptom control clinic in a cancer center: a retrospective study

“…Accepting the value of 3 in a 0-10 visual analogue scale as the threshold for mild to moderate intensity [20], most of the patients referred to the SCC clinic had low-intensity nausea and shortness of breath. These findings have been reported in similar groups before [10,21].…”

Metoclopramide Versus Hydromorphone for the Emergency Department Treatment of Migraine Headache

“…However, dosages of 1 mg/kg have been safely used among poisoned patients and oncology patients. 5,35 Our study was too small to assess effects of various dosages of metoclopramide. Future research should assess larger doses of metoclopramide among emergency department patients with migraines.…”

An open study of methotrimeprazine in the management of nausea and vomiting in patients with advanced cancer

“…Seven studies were identified in a systematic review from this department to determine the effectiveness of metoclopramide in relieving N/V in patients with advanced cancer (unpublished data). Three studies [11][12][13] were of randomised crossover design, three were case reports [14][15][16] and one [17] a retrospective case note review. There was a statistically significant improvement in nausea in three studies and of vomiting in two series, but the studies vary in quality and methodology, and the numbers of patients included is small.…”