There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Medication Options for Nausea in Liver Failure
- Ondansetron: a study published in 1996 1 found that ondansetron is primarily eliminated via hepatic metabolism, and liver disease may affect its clearance. The study suggested that patients with severe hepatic impairment should have their daily dose of ondansetron limited to 8 mg.
- Metoclopramide: a study published in 1985 2 found that metoclopramide is a safe and effective treatment for nausea and heartburn in patients with advanced liver disease.
- Other antiemetic options: a network meta-analysis published in 2021 3 compared the efficacy of different antiemetic treatment combinations, including 5-HT₃ receptor antagonists and NK₁ receptor antagonists, in preventing chemotherapy-induced nausea and vomiting. However, this study did not specifically focus on liver failure.
Considerations for Medication Selection
- Liver function: the choice of medication should take into account the patient's liver function, as some medications may be contraindicated or require dose adjustments in patients with liver disease.
- Potential for hepatotoxicity: some medications, such as valproic acid and phenytoin, have a well-recognized association with liver toxicity 4 and should be used with caution in patients with liver disease.
- Symptomatic treatment: symptomatic treatment with central antiemetics may be necessary for patients with chronic vomiting, but the choice of medication should be individualized based on the patient's specific needs and medical history 5.