Nausea and vomiting associated with opioid analgesia is relatively common and so should be prepared for in advance.



(1) Identify and treat conditions that may worsen nausea and vomiting prior to need.

(2) Start with low opioid doses and gradually increase.

(3) Administer oral doses with food.

(4) Alternate opioid agents and routes of administration.

(5) Reduce opioid-induced gastroparesis with metoclopramide.

(6) Consider administration of an anti-emetic agent if vomiting bothersome or other measures fail.

(7) Administer a laxative to reduce opioid-induced constipation.


Avoidance maneuvers:

(1) Avoid morphine.

(2) Avoid large intravenous and intramuscular doses.

(3) Avoid large doses by scheduling doses rather than waiting for pain to develop.

(4) Avoid other drugs causing nausea and vomiting.


Monitor the patients over the age of 40 years for respiratory depression if high doses are used.


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