Page 185 Guide to Pain Management in Low-Resource Settings

Hematologic Cancer with Nausea and Vomiting 173

Class of Drug Dose Comments
Benzodiazepines
Helpful for anticipatory nausea and vomiting. Diazepam
stings during i.v. administration; use a large vein and dilute
solution. For patients younger than 5 years, max. dosage is
0.05–0.2 mg/kg dose every 6 5 mg/dose. For patients older than 5 years, max. dosage is
Diazepam hours; i.v. = p.o. 10 mg/dose.
0.03–0.05 mg/kg dose every 5
hours to a maximum 4 mg/dose;
Lorazepam i.v. = p.o./s.l.
Corticosteroids
Helpful for hepatic capsular distention, anorexia, and
increased intracranial pressure. Can have long-term side
eff ects. If the patient weighs less than 10 kg, 1 mg/kg
6–10 mg loading dose, then 2–4 loading dose, and then 0.1–0.2 mg/kg 2–4 times a day for
mg 2–4 times a day for mainte- maintenance. Agonist eff ect when used in combination
Dexamethasone nance; i.m./i.v. = p.o. with serotonin antagonists.
1.5 mg dexamethasone = 10 mg
Prednisone prednisone
Cannabinoids
2.5 mg twice a day (for adults Can cause dysphoria, drowsiness, or hallucinations. Ap-
Dronabinol only) to a max of 20 mg/day petite stimulant.
Other Anticholinergics
Helpful for motion- or movement-related nausea and
Transdermal preparation: 0.5 mg vomiting. Well-tolerated by s.c. tissues. Often causes dry
changed every 72 hours; i.v./s.c.: mouth and blurred vision, and sometimes causes confu-
Scopolamine 0.006 mg/kg every 6 hours sion.

electroacupuncture by clinicians competent in its ad- details of all nonpharmacological and complementary

ministration for chemotherapy-induced nausea. Other and alternative modalities and gives examples of po-

modalities have not been well studied, but details are tential antiemetic benefi ts.
provided for a comprehensive analysis. Table 3 provides

Table 3
Nonpharmacologic and complementary and alternative modalities used to treat nausea and vomiting (adapted from the
National Comprehensive Cancer Network 2005)
Examples with Benefi t in Nausea
Modality Defi nition and Vomiting
Massage therapy Group of systematic and scientifi c manipulations of Reiki, therapeutic touch
body tissues best performed with the hands to aff ect
the nervous and muscular systems and general circula-
tion
Mind-body, other Methods that emphasize mind-body interactions with Meditation—transcendental and
relaxation techniques intended benefi ts that include relaxation and emo- mindfulness, yoga, prayer, guided
tional well-being imagery, relaxation training
Music therapy Th e use of music to help treat neurological, mental, Eff ective in postoperative nausea/
and behavioral disorders vomiting
Acupuncture therapy Treatment of symptoms by inserting needles along Acupuncture or acupressure at the
specifi c pathways Nei Guan or P6 point
Dietary supplements Products in capsule, tablet, liquid, or dried form, in- Ginger root, huangqi decoctions,
cluding vitamins, proteins, herbs, and other over-the- aromatherapy
counter substances intended for decreasing nausea
and vomiting