Nausea and vomiting

Nausea and vomiting are common, distressing symptoms, with significant impacts on physical functioning, psychological state, and social interaction. There are numerous causes including gastrointestinal, metabolic, treatment-related, vestibular, cranial, and psychological causes. Vomiting is mediated through pathways involving the nucleus of the solitary tract in the brainstem, with inputs from the gastrointestinal tract, viscera, vestibular system, area postrema, and higher centres. Nausea involves more complex connections between gut and brain. The roles of non-pharmacological strategies and medications (including levomepromazine, olanzapine, haloperidol, metoclopramide, domperidone, hyoscine hydrobromide, serotonin (5-HT3) antagonists, neurokinin antagonists, and others) are discussed. Emerging evidence in palliative care will facilitate optimum treatment.