From the Guidelines
Anti-nausea suppositories, such as prochlorperazine (Compazine) or promethazine (Phenergan), are effective treatments for nausea and vomiting when oral medications cannot be tolerated, as recommended by the NCCN Guidelines for Antiemesis 1.
Key Considerations
- The choice of anti-nausea suppository depends on the severity of nausea and the patient's individual response to different medications.
- Prochlorperazine (Compazine) suppositories, available in 25mg strength, can be used every 12 hours, while promethazine (Phenergan) suppositories are typically used in 12.5-25mg doses every 4-6 hours as needed.
- For severe nausea, other medications such as ondansetron (Zofran) may be prescribed, but the use of suppositories for this medication is not commonly recommended in the provided guidelines.
Administration and Storage
- When using suppositories, it is essential to wash hands before and after application, and insert the medication into the rectum pointed end first.
- Suppositories should be stored in a cool place, as they can melt at room temperature.
Monitoring and Follow-up
- Patients should contact their healthcare provider if nausea persists despite medication use or if they experience concerning side effects like severe dizziness or allergic reactions.
- The cause of nausea should be reassessed if symptoms persist for longer than a week, and opioid rotation or other interventions may be considered if necessary, as suggested by the NCCN Guidelines for Antiemesis 1 and the NCCN Guidelines for Palliative Care 1.
From the Research
Anti-Nausea Suppository Studies
- The studies provided do not directly discuss anti-nausea suppositories, but rather compare the efficacy of various antiemetic medications in preventing chemotherapy-induced nausea and vomiting (CINV) 2, 3, 4, 5, 6.
- The medications compared in these studies include ondansetron, prochlorperazine, dexamethasone, metoclopramide, nabilone, and palonosetron.
- The studies suggest that these medications have varying degrees of efficacy in preventing CINV, with some studies showing no significant difference between treatments 2, 6, while others show a significant reduction in nausea and vomiting with certain medications 3, 5.
Medication Efficacy
- Ondansetron has been shown to be effective in preventing acute CINV, with a relative risk of zero emesis of 1.72 (95% CI 1.45 to 1.97) compared to metoclopramide 3.
- Prochlorperazine has been shown to be effective in preventing delayed CINV, with patients receiving prochlorperazine reporting the lowest average nausea score on days 2 to 5 2.
- Dexamethasone has been shown to be effective in preventing delayed CINV, with a study showing that a dexamethasone-sparing regimen is noninferior to a 3-day dexamethasone regimen in terms of delayed total control rate 5.
Study Limitations
- The studies provided do not directly address the use of anti-nausea suppositories, and therefore do not provide information on their efficacy or safety.
- The studies have varying sample sizes and patient populations, which may limit the generalizability of the results.
- The studies use different outcome measures and definitions of success, which may make it difficult to compare results across studies.