Nausea and vomiting
Mangement and treatment
Treating the cause
Symptomatic management: non-pharmacological
- Symptomatic management: pharmacological
- Integral approach
Parenteral and rectal administration of antiemetics
Clinical question 3:
What are the differences in effectiveness between parenteral and rectal administration of antiemetics in patients with nausea and/or vomiting as a result of cancer, heart failure, COPD, ALS, MS or renal failure in the palliative phase?
When making a choice between rectal or parenteral administration of antiemetics, it is recommended to be primarily guided by the preference and situation of the patient, however within the possibilities of the care setting.
In general, oral administration of antiemetics is preferable. When oral administration is not possible or desirable, a choice can be made for rectal or parenteral administration.
One article has been found in which a comparison is made between rectal and intravenous administration of metoclopramide [Hardy 1990]. The article studied the pharmacokinetics of a dose of 150 mg metoclopramide, administered as a suppository (n=6) or as an intravenous bolus (dissolved in 10 ml 0.9% NaCl, administered in 10 minutes, n=5) to patients who were being treated with chemotherapy. Three patients received metoclopramide rectally as well as i.v. with a 48-hour time interval. Plasma levels were measured over 24 hours. Both forms of administration gave effective plasma levels. For the three patients receiving metoclopramide both intravenously and via a suppository, the suppository provided total systemic availability of metoclopramide.
The article does not make a pronouncement about the differences in burden on the patient. No literature was found on the burden on the patient.
There are indications that rectal and intravenous administration of metoclopramide yield comparable plasma levels.
No statement can be made about differences in burden associated with the form in which antiemetics is administered.
Whether rectal administration or parenteral administration of antiemetics is the least burdensome on the patient, is dependent on the preference and situation of the patient. In addition, it depends on the care setting whether parenteral administration is possible. Parenteral administration requires extra materials and competent staff. There is also a difference in costs: parenteral administration is much more expensive than rectal administration.