Chemotherapy induced nausea and vomiting

The Oncology Online Quality System (OOQS) provides up-to-date quality-controlled Edinburgh Cancer Centre documentation, including Clinical Management Guidelines by tumour group, SACT lists and procedures. OOQS includes guidelines for managing conditions associated with malignancy and treatment related side-effects.

Please see the CTAC Edinburgh Cancer Centre Anti-Emetic Guidance for Systemic Anti-Cancer therapy (SACT) on OOQS (under the heading Gastrointestinal complications/toxicity) or refer to local board haematology and oncology anti-emetic policy.

OOQS: SACT or SACT Toxicity (intranet)

Medicines sorted in descending order of SACT risk.
Refer to the anti-emetic guidance for dosage instructions and combinations advised.
Soluble or orodispersible tablets are restricted to use for patient who cannot swallow tablets. Give oral medication > 30 mins pre chemo.

Please refer to anti-emetic guidance for dosages.

History Notes

01/03/2023

East Region Formulary content agreed.

Please refer to anti-emetic guidance for dosages.

Prescribing Notes:

For additional information see the Edinburgh Cancer Centre (ECC) paper ‘Use of Metoclopramide in the Cancer & Palliative Care Service’ (NHS Lothian intranet).

History Notes

01/03/2023

East Region Formulary content agreed.

Please refer to anti-emetic guidance for dosages.

Use as a third line anti-emetic for CINV i.e. after prochlorperazine or levomepromazine.

Please refer to anti-emetic guidance for dosages.

Lorazepam to be used for anticipatory nausea, with or without any of the medications listed above.

Please refer to anti-emetic guidance for dosages.

Prescribing Notes:

For additional information see the Edinburgh Cancer Centre (ECC) paper ‘Use of Metoclopramide in the Cancer & Palliative Care Service’ (NHS Lothian intranet).

History Notes

01/03/2023

East Region Formulary content agreed.

Refer to the anti-emetic guidance for prescribing information – see prescribing notes.

Please refer to anti-emetic guidance for dosages.

See prescribing notes on MHRA Drug Safety Update for details of risk of anticholinergic side effects, including hyperthermia with hyoscine hydrobromide patches.

Please refer to anti-emetic guidance for dosages.

The ondansetron orodispersible formulations are relatively expensive compared to standard tablets and should only be considered when patients are continuously vomiting and are unable to take the standard tablets.

Please refer to anti-emetic guidance for dosages.

Prescribing Notes:

For prescribing information refer to Anti-emetic guidelines on NHS Lothian intranet page Children’s services Clinical Policies – Haematology and Oncology documents.
There have been a small number of reports of serious and life-threatening anticholinergic side effects associated with hyoscine hydrobromide patches, particularly when used outside the licence. See MHRA Drug Safety Update – Hyoscine hydrobromide patches: risk of anticholinergic side effects, including hyperthermia.
When using a medicine off-label for a child consider the appropriateness of the excipients for the child. For more information refer to Position Statements - Neonatal and Paediatric Pharmacist Group (NPPG) 2020 - choosing an oral liquid in children.

History Notes

09/04/2024

Addition of Levomepromazine hydrochloride 25mg/5ml oral solution sugar free, ERFC Dec 23.

09/11/2023

East Region Formulary content agreed.