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Haloperidol Syringe Driver — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyHaloperidol Syringe DriverSCE Medical Oncology

A 65-year-old woman with advanced cancer on opioids develops an ileus (absent bowel sounds, distended abdomen, vomiting). She cannot take oral medications. Her syringe driver contains morphine 60 mg/24h and midazolam 10 mg/24h. What anti-emetic can be added to the syringe driver?

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Correct answer: B — Haloperidol 1.5-5 mg/24h SC in the syringe driver — compatible with morphine and midazolam; haloperidol is the first-line anti-emetic for opioid/metabolic-related nausea via the syringe driver route

Haloperidol is the most commonly used anti-emetic in the syringe driver for cancer patients: (1) D2 receptor antagonism at the chemoreceptor trigger zone (effective for opioid/metabolic/renal nausea), (2) compatible with most common syringe driver drug combinations (morphine, midazolam, hyoscine butylbromide), (3) low volume and stable in solution. Typical dose: 0.5-1.5 mg/24h (anti-emetic) to 5-10 mg/24h (anti-emetic + mild sedative). Levomepromazine is the alternative broad-spectrum anti-emetic for refractory nausea. Cyclizine has compatibility issues at higher concentrations with some opioids.

Reference: Palliative Care Formulary; NICE NG31; ESMO Supportive Care