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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: 11-01-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Nausea and Vomiting

If patients are unable to tolerate oral medication, the subcutaneous route is the preferred route for administration of anti-emetic medication

Recommended: (TLS Green)

Metoclopramide

  • MHRA Metoclopramide: risk of neurological adverse effects
  • For nausea/vomiting associated with starting opioid medication, delayed gastric emptying

Cyclizine tablets / subcutaneous injection

  • For nausea/vomiting associated with intracranial disease

Alternatives: (TLS Blue)

Haloperidol tablets / liquid / capsules / subcutaneous injection

  • For nausea/vomiting associated with metabolic derangement or drugs

Domperidone tablets / suppositories

Levomepromazine 6mg tablets (unlicensed)/25mg subcutaneous injection

Specific indications: (TLS Blue)

Ondansetron tablets / injection

  • 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

Recommended: (TLS Green)

Hyoscine hydrobromide

  • For colic

Dexamethasone

Specific indication: (TLS Blue)

Octreotide

  • For high volume vomiting/fistula on advice of palliative care team
  • Awaiting Prescribing Guidance to be written

 

Hiccups

Recommended: (TLS Green)

Metoclopramide

Haloperidol

Alternatives: (TLS Blue)

Domperidone

Antacids

Omeprazole

Diazepam

Baclofen

Chlorpromazine

Dexamethasone

 

Constipation

Oral preparations

Recommended Stimulants: (TLS Green)

Senna

Bisacodyl

Recommended Softeners: (TLS Green)

Docusate sodium

Recommended Osmotic: (TLS Green)

Macrogols

Recommended Combined preparations: (TLS Green)

Co-danthramer

Co-danthrusate

  • Co-danthramer and co-danthrusate are only initiated for constipation in terminally ill patients of all ages
  • Please note that the liquid preparation is very high cost
  • Not to be used in patients who are faecally incontinent as superficial sloughing of discoloured skin may occur

Methylnaltrexone

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

Specific indication: (TLS Blue)

Macrogols

  • Faecal impaction
  • Dose = 8 sachets

 

Rectal preparations

Recommended Suppositories: (TLS Green)

Glycerine

Bisacodyl

Recommended Enemas: (TLS Green)

Sodium citrate (Micralax®)

Alternatives: (TLS Blue)

If Micralax® not successful:

Softener

Arachis oil

  • Not to be used if patient has a peanut allergy

Stimulant

Phosphate

 

Diarrhoea

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

Recommended: (TLS Green)

Loperamide

Alternative: (TLS Blue)

Codeine phosphate

Specific indications:

Creon® (TLS Blue)

  • For steatorrhoea due to pancreatic insufficiency

Octreotide (TLS Red)

  • For faecal fistulae and carcinoid syndrome

 

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