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Home > Formulary : Adult > Chapters > 16. Palliative Care >

BNSSG Adult Joint Formulary

16.2 Gastrointestinal symptoms- Palliative Care

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Last edited: 22-05-2025

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Nausea and Vomiting

If patients are unable to tolerate oral medication, or where absorption may be compromised, the subcutaneous route is the preferred route for administration of anti-emetic medication

Metoclopramide (TLS Green)

  • For nausea/vomiting associated with starting opioid medication or delayed gastric emptying
  • See MHRA Safety Update on Metoclopramide: risk of neurological adverse effects

Cyclizine (TLS Green)

  • For nausea/vomiting associated with intracranial disease

Haloperidol (TLS Blue)

  • For nausea/vomiting associated with metabolic derangement or drugs

Domperidone tablets (TLS Blue)

Levomepromazine tablets and subcutaneous injection (TLS Blue)

  • Note 6mg strength tablets are high cost

Ondansetron tablets / injection (TLS Blue)

  • For nausea and vomiting associated with therapy, chemotherapy or post abdominal surgery

Hyoscine hydrobromide transdermal patch

  • For treatment of nausea and vomiting associated with vestibular disorder; and as a result of medication side effects

 

Bowel Obstruction

Hyoscine butylbromide (TLS Green)

  • For colic

Dexamethasone (TLS Green)

Octreotide (TLS Amber Specialist Recommended)

  • For high volume vomiting/fistula on advice of palliative care team

 

Hiccups

Metoclopramide (TLS Green)

Haloperidol (TLS Green)

Domperidone (TLS Blue)

Antacids (TLS Blue)

Omeprazole (TLS Blue)

Diazepam (TLS Blue)

Baclofen (TLS Blue)

Chlorpromazine (TLS Blue)

Dexamethasone (TLS Blue)

 

Constipation

Oral preparations

Senna (TLS Green)

Bisacodyl (TLS Green)

Docusate sodium (TLS Green)

Macrogols (TLS Green)

Naloxegol (TLS Blue)

  • For opioid-induced constipation as per NICE TA345

Naldemedine (TLS Blue)

  • For opioid-induced constipation as per NICE TA651

Co-danthramer (TLS Amber Specialist Recommended)

Co-danthrusate (TLS Amber Specialist Recommended)

Methylnaltrexone (TLS Amber Specialist Recommended)

  • Used as rescue therapy where the oral/rectal route is inappropriate, on the advice of Palliative Care

 

Rectal preparations

Glycerine (TLS Green)

Bisacodyl (TLS Green)

Sodium citrate (Micralax®) (TLS Green)

Arachis oil (TLS Blue)

  • Not to be used if patient has a peanut allergy

Phosphates enema (TLS Blue)

 

Diarrhoea

Be sure that cause is not due to infection or excess laxative use before using anti-diarrheals

Loperamide (TLS Green)

Codeine phosphate (TLS Blue)

Creon® (TLS Blue)

  • For steatorrhoea due to pancreatic insufficiency

Octreotide (TLS Red)

  • For faecal fistulae and carcinoid syndrome

 

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