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Opioid Nausea Tolerance — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyOpioid Nausea ToleranceSCE Medical Oncology

A 55-year-old woman with cancer-related pain on strong opioids reports persistent nausea. What is the typical time course of opioid-induced nausea?

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Correct answer: A — Opioid-induced nausea typically resolves within 5-7 days as tolerance develops — a short course of antiemetic (haloperidol or metoclopramide) bridges this period

Opioid-induced nausea typically occurs at initiation or dose escalation and resolves within 5-7 days as the chemoreceptor trigger zone (CTZ) develops tolerance. Management: (1) haloperidol 1.5 mg PO nocte (D2 antagonist at the CTZ) or metoclopramide 10 mg TDS for 5-7 days, (2) cyclizine if vestibular component, (3) if nausea persists beyond 1 week, consider opioid rotation. Regular antiemetics are NOT needed long-term for most patients once tolerance develops. The most common PERSISTENT opioid side effect is constipation (no tolerance develops).

Reference: NICE CG140 Opioids in palliative care; ESMO Pain Management; Palliative Care Formulary