Nausea and vomiting are common and distressing symptoms in manypalliative carepatients.Identifying the cause or causes and treating the symptoms promptly can increase comfort and quality of life.
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Prevalence of Nausea and Vomiting Toward the End of Life
It almost goes without saying that nausea and vomiting—which very often occur together but can also occur independently of each other—are distressing symptoms. More importantly, they can prevent a patient from taking in an adequate level of hydration and nutrition as well as important medications.
Causes
There are several causes of nausea and vomiting. Noxious odors, tastes, or sights can sometimes trigger this response. Certain medications such as opioid analgesics (narcotic pain medications),NSAIDs, antibiotics, and chemotherapeutic agents can cause nausea as well.
Physical changes in the gastrointestinal tract such as constipation orbowel obstructionare yet other examples of causes.Because treatment of nausea and vomiting can largely depend on what’s causing it, your healthcare provider will do a thorough assessment to try to determine the cause.
Treatment
Treatment will begin with identifying the cause, and reversing it if possible. This may include removing or avoiding noxious stimuli, discontinuing unnecessary medications, andtreating constipation.Medications to treat nausea and vomiting may be used when the cause is irreversible or the symptoms persist despite treatment. Medications may include:
There are many different ways to administer most of the common medications to treat nausea and vomiting, which is especially important if pills are regurgitated before digestion. Some patients may be given a liquid form of the medicine if they can keep it down.
Sometimes medication will be given as a suppository (in the rectum) or even as a topical gel on the skin. There are other treatments that can be given along with medication or used while you’re waiting for a medication to arrive. Some things you can try that may help depending on the cause include:
As with any symptom, be sure to contact your healthcare provider immediately. Prompt treatment will help ensure that the patient gets comfortable as soon as possible.
Frequently Asked QuestionsYes, nausea and vomiting are very common at the end of life. Nausea and vomiting can be due to medication side effects or physical changes to the gastrointestinal tract, such as constipation or bowel obstruction.Nausea and vomiting at the end of life are treated in a few different ways depending on the cause of the upset stomach. The first treatment will be to eliminate the cause of nausea and vomiting if it is known. Sometimes this is a matter of changing medications or treating medication side effects, such as constipation. If there is no apparent cause, the doctor can prescribe medication to reduce nausea and vomiting.Medications used to treat nausea and vomiting at the end of life include:Ativan (lorazepam)Benadryl (diphenhydramine)Compazine (prochlorperazine)Dramamine (dimenhydrinate)Haldol (haloperidol)Motilium (domperidone)Phenergan (promethazine)Propulsid (cisapride)Reglan (metoclopramide)Scopolamine (hyoscine)ChlorpromazineZofran (ondansetron)
Frequently Asked Questions
Yes, nausea and vomiting are very common at the end of life. Nausea and vomiting can be due to medication side effects or physical changes to the gastrointestinal tract, such as constipation or bowel obstruction.
Nausea and vomiting at the end of life are treated in a few different ways depending on the cause of the upset stomach. The first treatment will be to eliminate the cause of nausea and vomiting if it is known. Sometimes this is a matter of changing medications or treating medication side effects, such as constipation. If there is no apparent cause, the doctor can prescribe medication to reduce nausea and vomiting.
Medications used to treat nausea and vomiting at the end of life include:Ativan (lorazepam)Benadryl (diphenhydramine)Compazine (prochlorperazine)Dramamine (dimenhydrinate)Haldol (haloperidol)Motilium (domperidone)Phenergan (promethazine)Propulsid (cisapride)Reglan (metoclopramide)Scopolamine (hyoscine)ChlorpromazineZofran (ondansetron)
Medications used to treat nausea and vomiting at the end of life include:
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Leach C.Nausea and vomiting in palliative care.Clin Med (Lond). 2019 Jul;19(4):299-301. doi:10.7861/clinmedicine.19-4-299National Cancer Institute.End-of-Life care for people who have cancer.Bryniarski P.Factors associated with lack of proper hydration in terminal cancer patients.JCO. 2017;35(31_suppl):195-195. doi:10.1200/JCO.2017.35.31_supplZhong W, Shahbaz O, Teskey G, et al.Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems.Int J Mol Sci. 2021;22(11):5797. doi:10.3390/ijms22115797National Library of Medicine.Bowel obstruction.Zuar LR, Thompson LA.What parents should know about constipation in children.JAMA Pediatr.2023;177(2):216. doi:10.1001/jamapediatrics.2022.5280American Academy of Family Physicians.Antiemetic medicines: OTC relief for nausea and vomiting.Ramirez R, Stalcup P, Croft B, Darracq MA.Haloperidol undermining gastroparesis symptoms (Hugs) in the emergency department.The American Journal of Emergency Medicine. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015James A, Nair MM, Abraham DS, Kovoor JS, Jose WM, Reghu R.Effect of Lorazepam in reducing psychological distress and anticipatory nausea and vomiting in patients undergoing chemotherapy.J Pharmacol Pharmacother. 2017;8(3):112-115. doi:10.4103/jpp.JPP_54_17American Cancer Society.Managing nausea and vomiting at home.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Leach C.Nausea and vomiting in palliative care.Clin Med (Lond). 2019 Jul;19(4):299-301. doi:10.7861/clinmedicine.19-4-299National Cancer Institute.End-of-Life care for people who have cancer.Bryniarski P.Factors associated with lack of proper hydration in terminal cancer patients.JCO. 2017;35(31_suppl):195-195. doi:10.1200/JCO.2017.35.31_supplZhong W, Shahbaz O, Teskey G, et al.Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems.Int J Mol Sci. 2021;22(11):5797. doi:10.3390/ijms22115797National Library of Medicine.Bowel obstruction.Zuar LR, Thompson LA.What parents should know about constipation in children.JAMA Pediatr.2023;177(2):216. doi:10.1001/jamapediatrics.2022.5280American Academy of Family Physicians.Antiemetic medicines: OTC relief for nausea and vomiting.Ramirez R, Stalcup P, Croft B, Darracq MA.Haloperidol undermining gastroparesis symptoms (Hugs) in the emergency department.The American Journal of Emergency Medicine. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015James A, Nair MM, Abraham DS, Kovoor JS, Jose WM, Reghu R.Effect of Lorazepam in reducing psychological distress and anticipatory nausea and vomiting in patients undergoing chemotherapy.J Pharmacol Pharmacother. 2017;8(3):112-115. doi:10.4103/jpp.JPP_54_17American Cancer Society.Managing nausea and vomiting at home.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Leach C.Nausea and vomiting in palliative care.Clin Med (Lond). 2019 Jul;19(4):299-301. doi:10.7861/clinmedicine.19-4-299National Cancer Institute.End-of-Life care for people who have cancer.Bryniarski P.Factors associated with lack of proper hydration in terminal cancer patients.JCO. 2017;35(31_suppl):195-195. doi:10.1200/JCO.2017.35.31_supplZhong W, Shahbaz O, Teskey G, et al.Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems.Int J Mol Sci. 2021;22(11):5797. doi:10.3390/ijms22115797National Library of Medicine.Bowel obstruction.Zuar LR, Thompson LA.What parents should know about constipation in children.JAMA Pediatr.2023;177(2):216. doi:10.1001/jamapediatrics.2022.5280American Academy of Family Physicians.Antiemetic medicines: OTC relief for nausea and vomiting.Ramirez R, Stalcup P, Croft B, Darracq MA.Haloperidol undermining gastroparesis symptoms (Hugs) in the emergency department.The American Journal of Emergency Medicine. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015James A, Nair MM, Abraham DS, Kovoor JS, Jose WM, Reghu R.Effect of Lorazepam in reducing psychological distress and anticipatory nausea and vomiting in patients undergoing chemotherapy.J Pharmacol Pharmacother. 2017;8(3):112-115. doi:10.4103/jpp.JPP_54_17American Cancer Society.Managing nausea and vomiting at home.
Leach C.Nausea and vomiting in palliative care.Clin Med (Lond). 2019 Jul;19(4):299-301. doi:10.7861/clinmedicine.19-4-299
National Cancer Institute.End-of-Life care for people who have cancer.
Bryniarski P.Factors associated with lack of proper hydration in terminal cancer patients.JCO. 2017;35(31_suppl):195-195. doi:10.1200/JCO.2017.35.31_suppl
Zhong W, Shahbaz O, Teskey G, et al.Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems.Int J Mol Sci. 2021;22(11):5797. doi:10.3390/ijms22115797
National Library of Medicine.Bowel obstruction.
Zuar LR, Thompson LA.What parents should know about constipation in children.JAMA Pediatr.2023;177(2):216. doi:10.1001/jamapediatrics.2022.5280
American Academy of Family Physicians.Antiemetic medicines: OTC relief for nausea and vomiting.
Ramirez R, Stalcup P, Croft B, Darracq MA.Haloperidol undermining gastroparesis symptoms (Hugs) in the emergency department.The American Journal of Emergency Medicine. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015
James A, Nair MM, Abraham DS, Kovoor JS, Jose WM, Reghu R.Effect of Lorazepam in reducing psychological distress and anticipatory nausea and vomiting in patients undergoing chemotherapy.J Pharmacol Pharmacother. 2017;8(3):112-115. doi:10.4103/jpp.JPP_54_17
American Cancer Society.Managing nausea and vomiting at home.
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