Nausea

(in surgical patients)

Etiology

  • Anesthesia
  • Opioids (PO > IV)
  • Post-operative ileus
  Mechanism Dosing Side effects
ondansetron (Zofran) 5-HT3 antagonist Post-op: 4 mg IV/IM 
GI-related: 8 mg PO/IV q8h PRN (sublingual tab)
Chemo: 8-24 mg PO

constipation, ↑ QT interval

Not very effective for opioid-related nausea
metoclopramide (Reglan) D2 antagonist 10 mg IV extrapyramidal sx - avoid in Parkinson's; avoid long (> 12 wks) duration
prochlorperazine (Compazine) D2 antagonist 5-10 mg PO/IV q6-8h, max 40 mg/d constipation, acute dystonic rxn, anticholinergic (avoid in older patients)
       
  • Opioid-related nausea
    • May trial Zofran, but if not effective (~ after 1 hr IV route), try Reglan or Compazine
    • Switching opioid may help nausea; ask what they have tolerated in the past
author: last edited: June 13, 2018, 4:42 p.m. | pk: 117 | unpublished