Nausea & Vomiting Drug Summary

Last updated: 06 October 2025
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Antacids, Antireflux Agents & Antiulcerants

Drug Dosage Remarks
Bismuth salicylate
(Bismuth subsalicylate)		 524 mg PO every ½-1 hour if needed
Max dose: 8 doses/day		 Adverse Reactions
  • Darkening of stool and tongue, hypersensitivity reactions
Special Instructions
  • Use with caution in patients with renal impairment
  • Avoid in patients with salicylate or aspirin sensitivity, history of severe GI bleeding and coagulopathy
Polymigel1 400-800 mg PO 6-8 hourly Adverse Reactions
  • GI effects (constipation, diarrhea, nausea/vomiting)
Special Instructions
  • Use with caution in patients with hypercalcemia, low phosphate diet, renal dysfunction; prolonged use
  • Avoid in patients with hypo- or hyperthyroidism, dialysis
1Combination with Oxetacaine is available. Please see the latest MIMS for specific formulation and prescribing information.

Antiemetics

Drug Dosage Remarks
Cyclizine Nausea/vomiting: 50 mg PO/IM/IV 8 hourly
Motion sickness: 50 mg PO 30 minutes before motion exposure
Prevention of PONV: 50 mg up to 8 hourly IM or slow IV injection
Should give first dose via slow IV injection 20 minutes before anticipated end of surgery 		Adverse Reactions
  • Drowsiness; rare: Fixed drug eruption, generalized chorea, hypersensitivity hepatitis
Special Instructions
  • Enhances effects of alcohol and other CNS depressants
  • Treatment should start within the first 24 hours of surgery and should not continue beyond 48 hours
Meclozine (Meclizine) Nausea/vomiting of pregnancy: 25-50 mg PO 24 hourly
Prevention and treatment of motion sickness: 25-50 mg PO the night before or 1 hour before motion exposure then 25-50 mg PO 24 hourly as needed
Prevention of radiation-related nausea/vomiting: 50 mg PO 2-12 hours before radiation therapy 		Adverse Reactions
  • CNS effects (drowsiness, fatigue); GI effects (dry mouth, vomiting); rarely blurred vision
Special Instructions
  • Use with caution in patients with glaucoma, breathing problem or prostatic enlargement
  • Avoid driving a car or operating machinery

Antihistamines

Drug Dosage Remarks
Buclizine Nausea/vomiting: 25-50 mg PO as a single dose
Max dose: 100 mg/day
Motion sickness: 25-50 mg PO as a single dose before travelling
May give further doses as needed
Max dose: 100 mg/day		 Adverse Reactions
  • CNS effects (drowsiness, dizziness, headache); GI effects (diarrhea, dyspepsia, dry mouth); Other effects (blurred vision, maculopapular rash)
Special Instructions
  • Use with caution in patients with increased eye pressure, GI obstruction or enlarged prostate or bladder neck obstruction
Diphenhydramine Nausea/vomiting: 25-50 mg PO 6-8 hourly as required
Nausea/vomiting of pregnancy: 25-50 mg PO 4-6 hourly as needed
Motion sickness: 25-50 mg PO 30 minutes before motion exposure then 25-50 mg PO 6 hourly as required
Max dose: 300 mg/day
or
10-50 mg deep IM injection or IV injection at a rate of 25 mg/min 30 minutes before motion exposure, repeated 6 hourly as required
Max dose: 400 mg/day		 Adverse Reactions
  • CNS effects (drowsiness, somnolence, lassitude, dizziness, headache, incoordination, paradoxical stimulation); Antimuscarinic effects (dry mouth, viscous secretions, urinary retention, blurred vision); GI effects (nausea/vomiting, diarrhea, epigastric pain, anorexia or increased appetite); CV effects (palpitations, arrhythmias, rarely hazardous ventricular arrhythmias); Dermatologic effects (rashes, hypersensitivity reactions)
Special Instructions
  • Use with caution in patients with epilepsy, hepatic or renal impairment, angle closure glaucoma, urinary retention, prostatic hyperplasia and in elderly patients
Hydroxyzine Nausea/vomiting: 25-100 mg PO 6-8 hourly
or
25-100 mg IM as a single dose
Promethazine Nausea/vomiting: 12.5-25 mg PO 4-6 hourly as needed
Max dose: 100 mg/day
or
12.5-25 mg rectally 4-6 hourly as needed
Nausea/vomiting of pregnancy: 12.5-25 mg PO 4-6 hourly as needed
Max dose: 100 mg/day
Motion sickness: 25-50 mg PO 1-2 hours before short motion exposure
or
25 mg PO at bedtime the night before prolonged motion exposure then repeat after 6-8 hours if needed
or
25 mg PO or rectally 30-60 minutes before travelling, may be repeated 8-12 hours later if needed
On subsequent travel days, may give 25 mg PO or rectally 12 hourly if needed
or
Treatment: 25 mg PO followed by 25 mg PO on the same evening and another 25 mg PO on the following evening
Max dose: 100 mg/day
Prevention and treatment of PONV: 12.5-25 mg PO 4-6 hourly as needed

Antispasmodics

Drug Dosage Remarks
Fenoverine 100 mg PO 8 hourly up to 200 mg PO 12 hourly Adverse Reactions
  • Myalgias, reversible rhabdomyolysis, gastric disturbances
Special Precautions
  • Avoid in patients with history of chronic liver disease, history of hyperthermia after anesthesia or after physical effort, mitochondrial myopathy, renal insufficiency
  • Use with caution in patients >60 years old and multiple drug therapy
Homatropine methylbromide Nausea/vomiting: 5-10 mg PO 3-4 hourly Adverse Reactions
  • Dry mouth and skin, thirst, decreased bronchial secretions, mydriasis
Special Precautions
  • Avoid in patients with prostatic enlargement
  • Use with caution in patients with narrow-angle glaucoma
Hyoscine Hyoscine HBr (Scopolamine HBr)
Nausea/vomiting and motion sickness:
200-1,000 mcg IM/IV/SC single dose
Motion sickness: Apply 1.5 mg patch behind the ear 4-6 hours before motion exposure; discard after journey
Prevention of PONV: Apply 1.5 mg patch behind the ear the evening before the surgery; discard 24 hours after the surgery
Hyoscine-N-butylbromide (Butylscopolamine)
Motion sickness: 300 mcg PO 30 minutes before motion exposure, then repeat 6 hourly if required
Max dose: 900 mcg/day
or
20 mg IV/SC/IM, repeated after 30 minutes if necessary
Max dose: 100 mg/day
Prevention and treatment of PONV:
10-20 mg PO 8 hourly up to 5x/day
or
20 mg IM/IV/SC, repeated as needed
Max dose: 100 mg/day 		Adverse Reactions
  • GI effects (dry mouth, thirst, difficulty in swallowing and talking, constipation); CNS effects (drowsiness, occasionally CNS stimulation); CV effects (transient bradycardia followed by tachycardia, arrhythmias, palpitations); Other effects (decreased bronchial secretions, rash, fatigue, mydriasis with cycloplegia, difficulty in urination)
Special Instructions
  • Use with caution in elderly patients, patients with heart failure, thyrotoxicosis, hypertension, diarrhea, paralytic ileus, prostatic enlargement, angle-closure glaucoma

Benzodiazepine

Drug Dosage Remarks
Lorazepam As adjunctive therapy to standard antiemetic drugs used prior to cancer chemotherapy: 1 mg PO at bedtime the night before chemotherapy and/or 1 mg PO 60 minutes prior to chemo and 6 and 12 hours after chemo, if needed Adverse Reactions
  • Dependence and withdrawal can occur especially in patients with history of drug dependence
  • CNS effects (sedation, drowsiness, muscle weakness, ataxia; less commonly, slurred speech, vertigo, headache, confusion); symptoms decrease after continued use
  • Paradoxical excitement can occur
Special Instructions
  • Elderly patients should receive lower doses

Butyrophenones

Drug Dosage Remarks
Droperidol Prevention and treatment of PONV: 0.625-1.25 mg slow IV injection over 30 minutes prior to anticipated end of surgery
Doses may be repeated 6 hourly as necessary
or
2.5 mg IM/slow IV injection
Additional 1.25 mg doses may be given to reach desired effect		 Adverse Reactions
  • CNS effects (extrapyramidal syndrome, CNS depression, somnolence); CV effects (hypotension, QT prolongation, torsade de pointes); Other effects (anticholinergic effects: Constipation, xerostomia, blurred vision, urinary retention)
Special Instructions
  • Use with caution in patients with visual problems, risk of QT prolongation, severe CV disease, renal and hepatic impairment, decreased GI motility, BPH, urinary retention, xerostomia
  • Contraindicated in patients with severe depression, significant cardiac disorders, Parkinson's disease, comatose states, bradycardia, hypokalemia
Haloperidol Nausea/vomiting: 1-1.5 mg PO 8-12 hourly
Chemotherapy-related nausea/vomiting: 0.5-5 mg PO 8-12 hourly and increase gradually
Prevention of PONV: 1-5 mg IM/IV at the end of surgery

Corticosteroid Hormones

Drug Dosage Remarks
Dexamethasone Prevention of chemotherapy-related nausea/vomiting and breakthrough nausea/vomiting:
Low emetic risk: 8 mg PO/IV single dose before chemo on day 1
Moderate emetic risk: 8 mg PO/IV single dose before chemo on day 1 then 8 mg PO/IV 24 hourly on days 2 and 3 without Aprepitant and 12 mg PO/IV single dose before chemo on day 1 with Aprepitant
High emetic risk: 12 mg PO/IV single dose before chemo on day 1 then 8 mg PO/IV 24 hourly on days 2-4
Prevention of radiation-induced nausea/vomiting:
Upper abdomen: 2 mg PO 8 hourly started before each day of radiotherapy
Prevention of PONV: 4-8 mg IV before anesthesia induction 		Adverse Reactions
  • Gastritis. If administered long-term: Adrenocortical insufficiency, osteoporosis, muscle wasting, pain or weakness, increased susceptibility to infection, impaired wound healing, electrolyte imbalances, weight gain, diabetes, skin thinning leading to striae and easy bruising, cataracts, glaucoma
Special Instructions
  • Take with food
  • Patients on long-term corticosteroids should receive preventive treatment for osteoporosis
Methylprednisolone Prevention of chemotherapy-related nausea/vomiting:
250 mg IV 1 hour before chemo, upon initiation of chemo and 1 hour after or at the time of discharge
May be given with Metoclopramide/Butyrophenone for severely emetogenic chemotherapy

Digestives

Drug Dosage Remarks
Pancreatin/Simethicone1 Pancreatin 170 mg/Simethicone 80 mg per caplet: 1-2 caplet PO 8 hourly Special Instructions
  • Take with or immediately after meals
1Combination product is available. Please see the latest MIMS for specific formulations and prescribing information.

Electrolytes

Drug Dosage Remarks
Potassium chloride (KCl) Severe deficiencies: 1,800-3,600 mg/day PO in divided doses Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, diarrhea); Other effect (hyperkalemia)
Special Instructions
  • Monitor serum electrolytes, ECG and clinical status particularly in the presence of cardiac or renal disease and acidosis
  • Avoid in patients using K-sparing diuretics

Neurokinin-1 Receptor Antagonists

Drug Dosage Remarks
Aprepitant Prevention of chemotherapy-related nausea/vomiting:
Moderately emetogenic:
125 mg PO 24 hourly 1 hour prior to chemo on day 1 followed by 80 mg PO in the morning on days 2 and 3 in combination with a 5-HT3 antagonist and corticosteroid on day 1
or
130 mg IV injection over 2 minutes 30 minutes prior to chemo on day 1 in combination with a 5-HT3 antagonist and an oral corticosteroid on day 1
or
100 mg IV injection over 2 minutes 30 minutes prior to chemo on day 1 followed by oral doses on days 2 and 3, in combination with a 5-HT3 antagonist on day 1 and an oral corticosteroid on day 1
Highly emetogenic:
125 mg PO 24 hourly 1 hour prior to chemo on day 1 followed by 80 mg PO in the morning on days 2 and 3 in combination with a 5-HT3 antagonist on day 1 and corticosteroid on days 1-4
or
130 mg IV injection over 2 minutes 30 minutes prior to chemo on day 1 in combination with a 5-HT3 antagonist on day 1 and an oral corticosteroid on days 1-4
Prevention of PONV:
40 mg PO within 3 hours prior to anesthesia induction
or
32 mg IV injection over 30 seconds 30 minutes prior to anesthesia induction 		Adverse Reactions
  • Fatigue, hiccups, constipation, increased ALT levels
  • Less common: Dizziness, tinnitus, dyspepsia, abdominal pain, anorexia
Special Instructions
  • Use with caution in patients with severe hepatic impairment
  • May interact with medications metabolized by CY3A4; for patients on Warfarin, monitor international normalized ratio (INR) closely for 2 weeks after administration; may reduce efficacy of oral contraception
  • Avoid co-administration with Pimozide, Terfenadine, Astemizole, Cisapride
Fosaprepitant Prevention of chemotherapy-related nausea/vomiting: 150 mg IV infusion over 20-30 minutes approximately 30 minutes before chemo on day 1 only
Given with a corticosteroid and 5-HT3 antagonist
Rolapitant Prevention of delayed chemotherapy-related nausea/vomiting associated with highly emetogenic chemotherapy:
180 mg PO once on day 1, given 1-2 hours before chemo
Additionally, 30 minutes prior to chemo on day 1, administer Dexamethasone (20 mg PO/IV) and a 5-HT3 antagonist; Dexamethasone (8 mg PO 12 hourly) should be continued on days 2, 3 and 4
Repeat Rolapitant administration at intervals of at least 2 weeks or more, prior to the start of each chemo cycle
Prevention of delayed chemotherapy-related nausea/vomiting associated with moderately emetogenic chemotherapy and combinations of Anthracycline and Cyclophosphamide: 180 mg PO once on day 1, given 1-2 hours before chemo
Additionally, 30 minutes prior to chemo on day 1, administer Dexamethasone (20 mg PO/IV) and a 5-HT3 antagonist
Follow the 5-HT3 antagonist dosing information regarding continued administration on days 2, 3 and 4
Repeat Rolapitant administration at intervals of at least 2 weeks or more, prior to the start of each chemo cycle 		Adverse Reactions
  • GI effects (hiccups, abdominal pain, dyspepsia); Hematologic effects (neutropenia, anemia); Other effects (decreased appetite, dizziness, UTI, stomatitis)
Special Instructions
  • Use with caution in patients who may become pregnant; in pregnancy and breast-feeding
  • Avoid in children <2 years old; co-administration with CYP2D6 substrates with a narrow therapeutic index (eg Thioridazine and Pimozide)

Peripheral Vasodilators & Cerebral Activators

Drug Dosage Remarks
Flunarizine Motion sickness:
10 mg PO before motion exposure		 Adverse Reactions
  • CNS effects (drowsiness, lassitude, dizziness, psychomotor impairment, EPS associated with depressive feelings have been reported); GI effects (dry mouth, constipation, gastric reflux, nausea/vomiting, diarrhea); Other effects (blurred vision, thickened resp secretions, urinary retention, increased appetite, weight gain)
Special Instructions
  • Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia or pyloroduodenal obstruction, renal and hepatic impairment

Phenothiazines

Drug Dosage Remarks
Chlorpromazine Nausea/vomiting: 10-25 mg PO 4-6 hourly
or
25 mg IM followed by 25-50 mg IM 3-4 hourly until vomiting stops
Prevention of PONV:
25-50 mg PO 2-3 hours before anesthesia induction		 Adverse Reactions
  • CNS effects (sedation, EPS [acute dystonia, akathisia and neuroleptic malignant syndrome], tardive dyskinesia, seizures/lowered seizure threshold, EEG abnormalities); Anticholinergic effects (dry mouth, urinary retention, blurred vision, constipation); CV effects (tachycardia, cardiac arrhythmias, hypotension [usually orthostatic]); Endocrine effects (galactorrhea, oligomenorrhea); Hematologic effects (agranulocytosis, leukopenia); Ophthalmic effects (pigmentary retinopathy, corneal opacities); Other effects (weight gain, sexual function disturbances, allergic rashes, hepatic dysfunction)
Special Instructions
  • Contraindicated in patients with pre-existing CNS depression or coma, bone marrow suppression, pheochromocytoma, prolactin-dependent tumors
  • Use with caution in patients with impaired liver, kidney, CV, cerebrovascular and respiratory function, angle-closure glaucoma, history of jaundice, Parkinson’s disease, DM, hypothyroidism, myasthenia gravis (MG), paralytic ileus, prostatic hyperplasia, urinary retention, epilepsy, seizures, in the presence of acute infection or leukopenia
  • The sedative effects are most marked during the first few days of administration
  • Monitor CBC in patients with fever or unexplained infection
Levomepromazine (Methotrimeprazine) Nausea/vomiting:
Ambulatory patient: Initial dose not >25-50 mg/day PO in 3 divided doses, higher dose to be taken at bedtime
Non-ambulant patient: 100-200 mg/day PO in 3 divided doses
May be increased to 1 g if necessary		 Adverse Reactions
  • Same as for Chlorpromazine
  • May be more sedating than Chlorpromazine
  • May cause severe postural hypotension
Special Instructions
  • Same as for Chlorpromazine
  • Patients on large initial doses or >50 years old should be recumbent when receiving medication to decrease the risk of postural hypotension
Perphenazine Nausea/vomiting: 8-16 mg/day PO in divided doses
Max dose: 24 mg/day		 Adverse Reactions
  • Same as for Chlorpromazine
  • Less likely to cause sedation than Chlorpromazine but EPS are more common
Special Instructions
  • Same as for Chlorpromazine
Prochlorperazine Prevention of nausea/vomiting:
5-10 mg PO 6-12 hourly
Max dose: 40 mg/day
Treatment of nausea/vomiting:
20 mg PO then 10 mg PO after 2 hours if needed
or
5-10 mg PO 6-8 hourly as needed
or
2.5-10 mg IV 3-4 hourly as needed
Max dose: 40 mg/day
or
5-10 mg IM, may repeat dose 3-4 hourly if needed
Max dose: 40 mg/day
or
12.5 mg deep IM injection followed by oral dose after 6 hours, if necessary
or
25 mg rectally 12 hourly as needed
Prevention of PONV:
5-15 mg PO 1 hour prior to anesthesia
or
5-10 mg IM 1-2 hours prior to anesthesia
May repeat once in 30 minutes if required
or
5-10 mg IV 15-30 minutes prior to anesthesia
May repeat once if required
Treatment of PONV:
5-15 mg PO post-op
or
5-10 mg IM/IV post-op
May repeat once if required		 Adverse Reactions
  • Same as for Chlorpromazine
  • Less likely to cause sedation, antimuscarinic effects but EPS are more common
Special Instructions
  • Same as for Chlorpromazine
Trifluoperazine Nausea/vomiting: 1-2 mg PO 12 hourly
Max dose: 6 mg/day		 Adverse Reactions
  • Same as for Chlorpromazine
  • Less likely to cause sedation, hypotension, hypothermia or antimuscarinic effects but EPS are more common (especially if doses >6 mg/day)
Special Instructions
  • Same as for Chlorpromazine

Propulsives

Drug Dosage Remarks
Clebopride Nausea/vomiting associated with chemotherapy, PONV, radiotherapy, infection:
0.5 mg PO 8 hourly before meals		 Adverse Reactions
  • Drowsiness, breast tension, dizziness
Special Instructions
  • Should be taken on an empty stomach
  • Avoid in patients in whom stimulation of muscular contractions may adversely affect GI conditions (eg GI hemorrhage, obstruction, perforation); avoid in patients with proven tardive dyskinesia to antipsychotics
Domperidone1 Nausea/vomiting: 10-20 mg PO 6-8 hourly 15-30 minutes before meals and at bedtime
May give up to 4 hourly if required		 Adverse Reactions
  • GI effects (abdominal cramps, dry mouth, abnormal liver function tests); Endocrine effects (elevated prolactin levels, galactorrhea, gynecomastia); Dermatologic effects (rash, urticaria); CNS effects (extrapyramidal reactions, drowsiness, headache)
  • Associated with increased risk of ventricular arrhythmia or sudden cardiac death, particularly with doses >30 mg/day or when used in patients >60 years old
Special Instructions
  • Use the lowest effective dose for the shortest duration necessary
  • Use with caution in patients with renal or mild hepatic impairment
  • Avoid in patients with prolactinoma, GI perforation, hemorrhage or obstruction, moderate or severe hepatic impairment, significant electrolyte disturbances, known existing prolongation of cardiac conduction intervals (particularly QTc), underlying cardiac disease, concomitant use of QT-prolonging drugs or CYP3A4 inhibitors
Itopride Nausea/vomiting: 50 mg PO 8 hourly before meals up to 8 weeks Adverse Reactions
  • CNS effects (dizziness, headache, tremor); Endocrine effects (increased prolactin level, gynecomastia); GI effects (diarrhea, constipation, abdominal pain, nausea, jaundice); Other effects (decreased WBC and platelet counts, rash, redness, itching, anaphylactoid reaction)
Special Instructions
  • Avoid in patients with GI hemorrhage, obstruction, or perforation
  • Acetylcholine action is enhanced and this may result in cholinergic side effects
Metoclopramide Disorders of gut motility:
5-10 mg PO 8 hourly or
10 mg IM/IV up to 8 hourly
Nausea/vomiting of pregnancy:
5-10 mg PO 6-8 hourly as required
or
5-10 mg IM/IV 6-8 hourly as required
Prevention and treatment of chemotherapy-related nausea/vomiting:
20-40 mg PO 4-6 hourly before chemo
or
1-2 mg/kg IV over 15 minutes, 30 minutes before chemo; may repeat 2-3 hourly x 5 doses
Max dose: 10 mg/kg/day
or
2-4 mg/kg continuous IV infusion over 15-30 minutes before chemo
Maintenance dose: 3-5 mg/kg as a continuous IV infusion over 8-12 hours
or
0.5 mg/kg/dose rectally 6 hourly
Prevention of delayed chemotherapy-related nausea/vomiting:
5-10 mg PO/IM/IV up to 8 hourly
Max dose: 30 mg/day or 0.5 mg/kg/day
or
0.5 mg/kg/day PO 6 hourly for 6 days, to be given 24 hours after chemo
Prevention of radiation-related nausea/vomiting: 10 mg PO up to 8 hourly
Max dose: 30 mg/day or 0.5 mg/kg/day
or
10 mg IM injection or IV injection over 3 minutes up to 8 hourly
Max dose: 30 mg/day or 0.5 mg/kg/day
Prevention and treatment of PONV:
10-20 mg IM/IV injection over at least 3 minutes before the end of surgery
Repeat 4-6 hourly as needed 		Adverse Reactions
  • CNS effects (restlessness, drowsiness, headache, extrapyramidal reactions and dystonic reactions have been reported eg tardive dyskinesia and parkinsonian symptoms); Endocrine effects (increased prolactin resulting in galactorrhea or gynecomastia); GI effect (diarrhea); CV effect (QT prolongation)
Special Instructions
  • Avoid in patients in whom stimulation of muscular contractions may adversely affect GI conditions (eg GI hemorrhage, obstruction, perforation)
  • Should be avoided in patients with pheochromocytoma, epilepsy, Parkinson’s disease, history of depression and in patients taking drugs that can also cause extrapyramidal symptoms
  • Use with caution in patients with renal or hepatic impairment
Mosapride 5 mg PO 8 hourly
or
15 mg PO 24 hourly		 Adverse Reactions
  • GI effects (diarrhea, dry mouth, increased LFTs, hepatic dysfunction, abdominal pain, nausea/vomiting); CNS effects (headache, dizziness); Hematologic effects (eosinophilia, leukopenia); Other effects (malaise, palpitations, increased triglycerides)
Special Instructions
  • May take before or after meals
  • Should not be taken for >2 weeks if no clinically therapeutic outcome is observed
  • Should be avoided in patients with GI hemorrhage, mechanical obstruction or perforation
1Combinations with Pantoprazole are available. Please see the latest MIMS for specific formulations and prescribing information.

Serotonin (5-HT3) Receptor Antagonists

Drug Dosage Remarks
Dolasetron Prevention of chemotherapy-related nausea/vomiting:
100 or 200 mg PO within 1 hour before chemo
Prevention of PONV: 50 mg PO at anesthesia induction
or
100 PO mg within 2 hours before surgery
Prevention and treatment of PONV: 12.5 mg IV at approximately 15 minutes before anesthesia cessation for prevention or given as soon as nausea/vomiting is present for treatment 		Adverse Reactions
  • GI effects (constipation, diarrhea, asymptomatic rise in aminotransferases); Other effects (headache, flushing, blurred vision and dizziness with rapid infusion)
  • Rarely immediate, severe hypersensitivity reactions (eg anaphylaxis), extrapyramidal reactions, seizures, chest pain with or without ST-segment depression, arrhythmias, hypotension, bradycardia
  • Dolasetron: Dose-dependent PR, QRS and QT prolongation
  • Palonosetron: Pruritus
Special Instructions
  • Use with caution in patients with cardiac comorbidities, concomitant electrolyte abnormalities, signs of subacute intestinal obstruction
  • Dolasetron: IV administration is not intended for prophylaxis of chemotherapy-associated nausea/vomiting

 
 
 
 
 
Granisetron Prevention of chemotherapy-related nausea/vomiting:
1 patch (3.1 mg/24 hr) on upper outer arm 1-2 days prior to chemo and remove at least 24 hours after end of chemo
or
10 mg SC 30 minutes prior to chemo on day 1
Do not administer more frequently than once every 7 days
Prevention and treatment of chemotherapy-related nausea/vomiting:
1 mg PO 12 hourly start 1 hour prior to chemo
or
2 mg PO single dose 1 hour prior to chemo
or
1-2 mg PO within 1 hour prior to chemo, then 2 mg PO 24 hourly as a single dose or 12 hourly for up to 1 week after treatment
or
1-3 mg IV prior to chemo, may give up to 3 doses 10 minutes apart in 24 hours
or
3 mg IM 15 minutes prior to chemo
Max dose: 9 mg/day
Prevention of radiation-related nausea/vomiting:
2 mg PO single dose within 1 hour of radiation
or
1-3 mg IV prior to radiation 24 hourly
Prevention of PONV:
1 mg IV injection over 30 seconds single dose before anesthesia induction
Treatment of PONV:
1 mg IV injection over 30 seconds
Max dose: 3 mg/day
Ondansetron Prevention of chemotherapy-related nausea/vomiting:
16 mg rectally 2 hours before treatment
or
Moderately emetogenic: 8 mg PO given 0.5-2 hours prior to chemo followed by 8 mg PO after 8 or 12 hours or
8 mg IV/IM single dose prior to chemo or
0.15 mg/kg IV infusion 30 minutes prior to chemo then repeated after 4 and 8 hours from the initial dose for a total of 3 doses
Highly emetogenic: 24 mg PO as a single dose given 0.5-2 hours prior to chemo or
8 mg IV/IM single dose immediately before chemo
May be followed either by 8 mg IV/IM 4 hourly for 2 more doses or 1 mg/hr continuous IV infusion for up to 24 hours
Max dose: 16 mg
Prevention of delayed emesis following chemotherapy:
8 mg PO 12 hourly for up to 5 days after a course of treatment
or
16 mg rectally 24 hourly for up to 5 days after a course of treatment
Prevention of radiation-related nausea/vomiting:
8 mg PO 8 hourly
or
8 mg slow IV/IM inj single dose immediately before treatment
or
16 mg rectally 24 hourly for up to 5 days after a course of treatment for protection against delayed emesis
Total body irradiation (TBI): 8 mg PO 1-2 hours prior to daily fraction of radiotherapy
Daily fractionated or single high-dose fraction radiation to the abdomen: 8 mg PO 1-2 hours prior to radiotherapy, followed by 8 mg PO 8 hourly after the first dose for 1-2 days after completion of radiotherapy
Prevention of PONV:
8 mg PO single dose 1 hour before anesthesia induction followed by 8 mg PO 8 hourly x 2 doses
or
16 mg PO single dose 1 hour before anesthesia induction
or
4 mg IV/IM single dose 1 hour prior to anesthesia induction
Treatment of PONV: 4 mg IM/IV single dose postoperatively
Palonosetron Prevention of chemotherapy-related nausea/vomiting: 500 mcg PO 1 hour before chemo
or
250 mcg IV over 30 seconds single dose given 30 minutes before chemo
Prevention of PONV: 75 mcg IV over 10 seconds single dose immediately before anesthesia induction
Ramosetron Prevention of chemotherapy-related nausea/vomiting: 100 mcg PO 24 hourly 1 hour before chemo
Treatment of chemotherapy-related nausea/vomiting: 300 mcg IV 24 hourly
Max dose: 600 mcg/day
Prevention of PONV: 300 mcg IV 24 hourly
Max dose: 600 mcg/day
Tropisetron Prevention of chemotherapy-related nausea/vomiting: 5 mg IV 15 minutes before chemo on day 1 then 5 mg PO 24 hourly on days 2-6
Prevention of PONV: 2-5 mg IV before anesthesia induction
Treatment of PONV: 2-5 mg IV within 2 hours of end of anesthesia
Combination Product
Palonosetron/Netupitant Palonosetron 0.5 mg/Netupitant 300 mg per cap: 1 cap PO approximately 1 hour prior to initiation of each chemo cycle Adverse Reactions
  • GI effects (dyspepsia, abdominal pain, nausea, flatulence, diarrhea, hiccups); CV effects (cardiomyopathy, bundle branch block, AV block, conduction disorder); Other effects (hypersensitivity, constipation, serotonin syndrome, fatigue, asthenia, weakness)
Special Instructions
  • Use with caution in patients with history of constipation or signs or subacute intestinal obstruction, history of QT prolongation, CHF, bradyarrhythmia, electrolyte abnormalities, conduction disturbance
  • Avoid in patients with severe hepatic and renal impairment; pregnancy and lactation

Vitamin B Complex/With C

Drug Dosage Remarks
Pyridoxine (Vitamin B6)1 Nausea/vomiting of pregnancy:
10-25 mg PO 6-8 hourly		 Adverse Reactions
  • High-dose Pyridoxine supplements taken over prolonged periods of time have been reported to cause neuropathy
1Various combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

Other Antiemetics

Drug Dosage Remarks
Dronabinol Treatment of chemotherapy-related nausea/vomiting refractory to conventional antiemetic agents: 5 mg/m2/dose PO 1-3 hours prior to chemo then 2-4 hourly for a total of 4-6 doses/day
Max dose: 15 mg/m2/dose for 4-6 doses/day
or
4.2 mg/m2/dose PO 1-3 hours prior to chemo then 2-4 hourly for a total of 4-6 doses/day
Max dose: 12.6 mg/m2/dose for 4-6 doses/day		 Adverse Reactions
  • GI effects (abdominal pain, diarrhea, nausea/vomiting); CNS effects (dizziness, delirium, mania, seizures); Other effects (bradycardia, chills, fatigue, rash, sinusitis, tinnitus, myalgia)
Special Precautions
  • Use with caution in patients with cardiac disease, dementia, seizures, psychiatric disorders; CYP2C9 poor metabolizer
Antivertigo Drugs
Betahistine Nausea/vomiting: 8-16 mg PO 8 hourly
or
24 mg PO 12 hourly
Max dose: 48 mg/day		 Adverse Reactions
  • GI disturbances, rashes, pruritus
Special Precautions
  • Use with caution in patients with asthma, PUD, pheochromocytoma
Cinnarizine Nausea/vomiting: 12.5-25 mg PO 8 hourly
Motion sickness: 25-30 mg PO 2 hours before motion exposure then 12.5-25 mg PO 8 hourly		 Adverse Reactions
  • CNS effects (drowsiness, lassitude, dizziness, psychomotor impairment, EPS associated with depressive feelings have been reported); GI effects (dry mouth, constipation, gastric reflux, nausea/vomiting, diarrhea); Other effects (blurred vision, thickened respiratory secretions, urinary retention, increased appetite, weight gain)
Special Instructions
  • Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia, or pyloroduodenal obstruction, renal and hepatic impairment
Difenidol (Diphenidol) Motion sickness: 25-50 mg PO 8 hourly up to 6x/day Special Instructions
  • Reduce dosage if thirst, heartburn, palpitations and mydriasis occur
  • Avoid in patients with renal failure
  • Use with caution or not at all in patients with glaucoma, sinus tachycardia, obstructive lesions of the GIT
Dimenhydrinate Nausea/vomiting: 50-100 mg PO/rectally 6-8 hourly
Nausea/vomiting of pregnancy: 25-50 mg PO 4-8 hourly
Max dose: 400 mg/day
or
50 mg IV 4-6 hourly as needed
Prevention of motion sickness:
50 mg PO 30 minutes-1 hour before motion exposure, then 50-100 mg PO 4-6 hourly as needed
Max dose: 400 mg/day
or
50-100 mg IV/IM 4 hourly as needed
Max dose: 400 mg/day
or
50-100 mg rectally 30 minutes-2 hours before traveling
Treatment of motion sickness:
50-100 mg PO/IV/IM 4-6 hourly
Max dose: 400 mg/day
Prevention and treatment of PONV:
50-100 mg PO 6-8 hourly
or
50 mg IV/IM 4 hourly		 Adverse Reactions
  • CNS effects (drowsiness, dizziness, headache); GI effects (dry mouth, GI disturbances); Other effect (blurred vision)
Special Instructions
  • Avoid alcohol
  • Use with caution in patients with narrow-angle glaucoma, urinary retention, prostatic hypertrophy

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs