Table 1.

Selected Agents for Managing Side Effects of Opioids

Nausea/VomitingPruritusSedation
Metoclopramide* 10 mg po/IV q 4 hours prnDiphenhydramine* 25–50 mg po/IV q 12 hoursCaffeine
Prochlorperazine* 10 mg po/IV q 4hours, or 25 mg PR q 8 hoursHydrocortisone 1% cream to affected area q 6 hoursDextroamphetamine 2.5–10 mg po
Add meclizine if motion exacerbates symptomsDexamethasone 1 mg po q dayMethylphenidate 2.5–10 mg po q day to TID
If severe: Transdermal scopolamine or 5HT3 antagonist(Modafinil 100 to 400 mg q day is almost 5× as expensive as methylphenidate)
  • * Available in liquid form.

    q, every; prn, as needed; po, by mouth; IV, intravenous; TID, 3 times per day.

  • Ondansetron is available in both liquid and oral transdermal forms.