| Prokinetics |
Metoclopramide |
30–40* mg/day s.c.* |
Drug of choice when incomplete obstruction or functional disorder is suspected. Because it promotes GI motility, pain and vomiting may increase. Caution: This drug should be stopped if complete obstruction is present |
| Antipsychotics |
Haloperidol* |
2.5–10 mg/day s.c.* or i.v.* |
Drug of choice when complete obstruction is present and no prokinetic antiemetic can be used |
| Levomepromazine* |
1–5 mg oral/s.c.* at night |
Dose may be increased up to 25 mg/day, but this is rarely necessary |
| Olanzapine* |
2.5 mg as initial dose, if needed, 5–10 mg oral/s.l. daily |
Use with caution in older patients and those with dementia, due to increased half-life and increased mortality risk |
| Antihistamines |
Dimenhydrinate |
150 mg p.r. 62–400 mg/day s.c.* or i.v. |
Has a sedative effect |
| Setrons |
Ondansetron* |
8 mg oral or s. l./ s.c.*/ i.v. 2–3× daily |
Increases constipation |
| Granisetron* |
1–2 mg p.o./s.c.*/ i.v. 1× daily |
Increases constipation; dose may be increased up to 9 mg/day |
| Anticholinergics |
Butylscopolamine* |
40–80 mg/day s.c./i.v. dose may be increased up to 120 mg* |
Used to reduce GI secretion; has no direct antiemetic effect. May increase oral dryness and thirst |
| Somatostatin analogs |
Octreotide* |
Initial dose 100 µg 12-hourly, dose may be increased up to 750 µg/day, further increase rarely has greater effect |
Used to reduce GI secretion; second-line drug (because expensive) |
| Lanreotide* |
60 mg deep s.c. in upper outer quadrant of buttock every 3 months |
If necessary, 120 mg every 4 weeks |
| H2-blockers |
Ranitidine* |
50 mg 2–4× daily, or continuously 100–200 mg/ 24 h i.v. |
|
| Proton pump inhibitors |
Omeprazole* |
40–80 mg/day i.v, s.c.* |
|
| Corticosteroids |
Dexamethasone* |
8–12 mg/day s.c.*/ i.v. |
Used to reduce peritumoral edema (may restore passage of bowel contents) and for antiemesis; fewer mineralocorticoid adverse effects than methylprednisolone |
