Nausea and vomiting medical therapy: Difference between revisions
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{{CMG}} {{AE}} {{VVS} | {{CMG}} {{AE}} {{VVS} | ||
==Overview== | ==Overview== | ||
Mainstay of treatment of [[nausea]] and [[vomiting]] is correcting any [[electrolyte imbalance]], [[dehydration]], [[malnutrition]], and suppression of [[symptoms]] while evaluating and treating the underlying cause. [[Dietary]] recommendations include a low-[[fat]], low-[[fiber]] diet with frequent small meals if able to tolerate [[oral]] intake. Liquid diet is recommended in case solid diet is not well tolerated. Medical therapy involves two groups of [[drugs]] i.e., [[antiemetics]] and [[prokinetics]]. Antiemetics suppress nausea and vomiting and typically act [[centrally]]. Prokinetics modulate [[gastrointestinal]] [[motility]]. | |||
== Medical Therapy == | == Medical Therapy == | ||
* Mainstay of treatment of nausea and vomiting is correcting any electrolyte imbalance, dehydration, malnutrition, and suppression of symptoms while evaluating and treating the underlying cause. <ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref> | * Mainstay of treatment of [[nausea]] and [[vomiting]] is correcting any [[electrolyte imbalance]], [[dehydration]], [[malnutrition]], and [[suppression]] of [[symptoms]] while evaluating and treating the underlying cause. <ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref> | ||
* Dietary recommendations include a low-fat, low-fiber diet with frequent small meals if able to tolerate oral intake. Liquid diet is recommended in case solid diet is not well tolerated. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> | * [[Dietary]] recommendations include a low-[[fat]], low-[[fiber]] diet with frequent small meals if able to tolerate [[oral]] intake. Liquid diet is recommended in case solid diet is not well tolerated. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> | ||
* Medical therapy involves two groups of drugs i.e., antiemetics and prokinetics. Antiemetics suppress nausea and vomiting and typically act centrally. Prokinetics modulate gastrointestinal motility. | * Medical therapy involves two groups of [[drugs]] i.e., [[antiemetics]] and [[prokinetics]]. Antiemetics suppress nausea and vomiting and typically act [[centrally]]. Prokinetics modulate [[gastrointestinal]] [[motility]]. | ||
===Antiemetics=== | ===Antiemetics=== | ||
* Benzodiazepines are used for anticipatory nausea and postoperative nausea and vomiting. Eg., Lorazepam 0.5-2mg oral, SL (sublingual) or IM (intramuscular), Alprazolam 0.25-1mg oral or IV (intravenous). <ref name="pmid8123420">{{cite journal |vauthors=Di Florio T, Goucke R |title=Reduction of dopamine release and postoperative emesis by benzodiazepines |journal=Br J Anaesth |volume=71 |issue=2 |pages=325 |date=August 1993 |pmid=8123420 |doi=10.1093/bja/71.2.325 |url=}}</ref> | * [[Benzodiazepines]] are used for [[anticipatory]] [[nausea]] and [[postoperative]] [[nausea]] and [[vomiting]]. Eg., [[Lorazepam]] 0.5-2mg oral, SL ([[sublingual]]) or IM ([[intramuscular]]), [[Alprazolam]] 0.25-1mg [[oral]] or IV ([[intravenous]]). <ref name="pmid8123420">{{cite journal |vauthors=Di Florio T, Goucke R |title=Reduction of dopamine release and postoperative emesis by benzodiazepines |journal=Br J Anaesth |volume=71 |issue=2 |pages=325 |date=August 1993 |pmid=8123420 |doi=10.1093/bja/71.2.325 |url=}}</ref> | ||
*Serotonin antagonists are used in postoperative, post-radiation and chemotherapy induced nausea and vomiting. Eg., Ondansetron 4-8mg oral or IV, Granisetron 1-2 mg every 4-8 hours or 0.075mg-0.25mg every 24 hours oral or IV. <ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref> | *[[Serotonin]] [[5-HT3]] [[antagonists]] are used in postoperative, post-[[radiation]] and [[chemotherapy]] induced nausea and vomiting. Eg., [[Ondansetron]] 4-8mg oral or IV, [[Granisetron]] 1-2 mg every 4-8 hours or 0.075mg-0.25mg every 24 hours oral or IV. <ref name="pmid14724837">{{cite journal |vauthors=Hasler WL, Chey WD |title=Nausea and vomiting |journal=Gastroenterology |volume=125 |issue=6 |pages=1860–7 |date=December 2003 |pmid=14724837 |doi=10.1053/j.gastro.2003.09.040 |url=}}</ref> | ||
*Antihistamines are used in motion sickness and labrythitis. Eg., Meclizine 25-50mg every 24 hours oral, Diphenhydramine, Cyclizine, Hydroxazine 25-50mg every 6-8 hours, 25–75 mg every 8 hours, 25–50 mg every 4–6 hours, 25–100 mg every 6–8 hours oral, IM or IV. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> <ref name="pmid15023018">{{cite journal |vauthors=Flake ZA, Scalley RD, Bailey AG |title=Practical selection of antiemetics |journal=Am Fam Physician |volume=69 |issue=5 |pages=1169–74 |date=March 2004 |pmid=15023018 |doi= |url=}}</ref> | *[[Antihistamines]] are used in [[motion sickness]] and [[labrythitis]]. Eg., [[Meclizine]] 25-50mg every 24 hours oral, [[Diphenhydramine]], [[Cyclizine]], [[Hydroxazine]] 25-50mg every 6-8 hours, 25–75 mg every 8 hours, 25–50 mg every 4–6 hours, 25–100 mg every 6–8 hours oral, IM or IV. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url=}}</ref> <ref name="pmid15023018">{{cite journal |vauthors=Flake ZA, Scalley RD, Bailey AG |title=Practical selection of antiemetics |journal=Am Fam Physician |volume=69 |issue=5 |pages=1169–74 |date=March 2004 |pmid=15023018 |doi= |url=}}</ref> | ||
* | *[[Anticholinergic]] agents are used in [[motion sickness]]. Eg., [[Scopolamine]] 0.3–0.6 mg every 24 hours SL, IV, IM or [[transdermal]]. <ref name="pmid11208736">{{cite journal |vauthors=Quigley EM, Hasler WL, Parkman HP |title=AGA technical review on nausea and vomiting |journal=Gastroenterology |volume=120 |issue=1 |pages=263–86 |date=January 2001 |pmid=11208736 |doi=10.1053/gast.2001.20516 |url=}}</ref> <ref name="pmid9205824">{{cite journal |vauthors=Golding JF, Stott JR |title=Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate |journal=Br J Clin Pharmacol |volume=43 |issue=6 |pages=633–7 |date=June 1997 |pmid=9205824 |pmc=2042789 |doi=10.1046/j.1365-2125.1997.00606.x |url=}}</ref> | ||
*Phenothiazines are antidopaminergics which are effective for migraine, motion sickness, vertigo, postoperative and chemotherapy induced nausea | *[[Phenothiazines]] are [[antidopaminergics]] which are effective for [[migraine]], [[motion sickness]], [[vertigo]], postoperative and chemotherapy induced nausea and vomiting. Eg., [[Prochlorperazine]], [[Promethazine]], [[Chlorpromazine]], [[Perphenazine]] 5–10 mg every 6–8 hours, 12.5 –25 mg every 4–6 hours, 10–25 mg every 4–6 hours, 4–8 mg every 8–12 hours Oral, IV or IM. <ref name="pmid16934536">{{cite journal |vauthors=Sanger GJ, Andrews PL |title=Treatment of nausea and vomiting: gaps in our knowledge |journal=Auton Neurosci |volume=129 |issue=1-2 |pages=3–16 |date=October 2006 |pmid=16934536 |doi=10.1016/j.autneu.2006.07.009 |url=}}</ref> <ref name="pmid18321441">{{cite journal |vauthors=Chepyala P, Olden KW |title=Nausea and vomiting |journal=Curr Treat Options Gastroenterol |volume=11 |issue=2 |pages=135–44 |date=April 2008 |pmid=18321441 |doi=10.1007/s11938-008-0026-6 |url=}}</ref> | ||
*Droperidol is a Butyrophenone and a restricted drug used for postoperative and chemotherapy induced nausea and vomiting, 0.625–1.25 mg every 24hours IM or IV <ref name="pmid11208736">{{cite journal |vauthors=Quigley EM, Hasler WL, Parkman HP |title=AGA technical review on nausea and vomiting |journal=Gastroenterology |volume=120 |issue=1 |pages=263–86 |date=January 2001 |pmid=11208736 |doi=10.1053/gast.2001.20516 |url=}}</ref> | *[[Droperidol]] is a [[Butyrophenone]] and a [[restricted drug]] used for postoperative and [[chemotherapy]] induced nausea and vomiting, 0.625–1.25 mg every 24hours IM or IV <ref name="pmid11208736">{{cite journal |vauthors=Quigley EM, Hasler WL, Parkman HP |title=AGA technical review on nausea and vomiting |journal=Gastroenterology |volume=120 |issue=1 |pages=263–86 |date=January 2001 |pmid=11208736 |doi=10.1053/gast.2001.20516 |url=}}</ref> | ||
* Cannabinoids are used for chemotherapy induced nausea and vomiting. Eg., Dronabinol, Nabilone 2.5–10 mg every 6–8 hours, 1–2 mg every 8–12 hours oral. <ref name="pmid18321441">{{cite journal |vauthors=Chepyala P, Olden KW |title=Nausea and vomiting |journal=Curr Treat Options Gastroenterol |volume=11 |issue=2 |pages=135–44 |date=April 2008 |pmid=18321441 |doi=10.1007/s11938-008-0026-6 |url=}}</ref> <ref name="pmid375088">{{cite journal |vauthors=Herman TS, Einhorn LH, Jones SE, Nagy C, Chester AB, Dean JC, Furnas B, Williams SD, Leigh SA, Dorr RT, Moon TE |title=Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy |journal=N Engl J Med |volume=300 |issue=23 |pages=1295–7 |date=June 1979 |pmid=375088 |doi=10.1056/NEJM197906073002302 |url=}}</ref> | * [[Cannabinoids]] are used for [[chemotherapy]] induced nausea and vomiting. Eg., [[Dronabinol]], [[Nabilone]] 2.5–10 mg every 6–8 hours, 1–2 mg every 8–12 hours oral. <ref name="pmid18321441">{{cite journal |vauthors=Chepyala P, Olden KW |title=Nausea and vomiting |journal=Curr Treat Options Gastroenterol |volume=11 |issue=2 |pages=135–44 |date=April 2008 |pmid=18321441 |doi=10.1007/s11938-008-0026-6 |url=}}</ref> <ref name="pmid375088">{{cite journal |vauthors=Herman TS, Einhorn LH, Jones SE, Nagy C, Chester AB, Dean JC, Furnas B, Williams SD, Leigh SA, Dorr RT, Moon TE |title=Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy |journal=N Engl J Med |volume=300 |issue=23 |pages=1295–7 |date=June 1979 |pmid=375088 |doi=10.1056/NEJM197906073002302 |url=}}</ref> | ||
* Corticosteroids are used for acute or delayed chemotherapy induced or postoperative nausea and vomiting. Eg., Dexamethasone 4–8 mg every 4–6 hours Oral, IM or IV. <ref name="pmid18321441">{{cite journal |vauthors=Chepyala P, Olden KW |title=Nausea and vomiting |journal=Curr Treat Options Gastroenterol |volume=11 |issue=2 |pages=135–44 |date=April 2008 |pmid=18321441 |doi=10.1007/s11938-008-0026-6 |url=}}</ref> <ref name="pmid15190136">{{cite journal |vauthors=Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N |title=A factorial trial of six interventions for the prevention of postoperative nausea and vomiting |journal=N Engl J Med |volume=350 |issue=24 |pages=2441–51 |date=June 2004 |pmid=15190136 |pmc=1307533 |doi=10.1056/NEJMoa032196 |url=}}</ref> | * [[Corticosteroids]] are used for [[acute]] or [[delayed]] chemotherapy induced or postoperative nausea and vomiting. Eg., [[Dexamethasone]] 4–8 mg every 4–6 hours Oral, IM or IV. <ref name="pmid18321441">{{cite journal |vauthors=Chepyala P, Olden KW |title=Nausea and vomiting |journal=Curr Treat Options Gastroenterol |volume=11 |issue=2 |pages=135–44 |date=April 2008 |pmid=18321441 |doi=10.1007/s11938-008-0026-6 |url=}}</ref> <ref name="pmid15190136">{{cite journal |vauthors=Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N |title=A factorial trial of six interventions for the prevention of postoperative nausea and vomiting |journal=N Engl J Med |volume=350 |issue=24 |pages=2441–51 |date=June 2004 |pmid=15190136 |pmc=1307533 |doi=10.1056/NEJMoa032196 |url=}}</ref> | ||
* NK-1 Receptor Antagonist is used in acute as well as delayed chemotherapy-induced nausea and vomiting. It has also been used in gastroparesis-associated nausea and vomiting. Eg., Aprepitant 80–125 mg every 24 hours oral. <ref name="pmid18208572">{{cite journal |vauthors=Madsen JL, Fuglsang S |title=A randomized, placebo-controlled, crossover, double-blind trial of the NK1 receptor antagonist aprepitant on gastrointestinal motor function in healthy humans |journal=Aliment Pharmacol Ther |volume=27 |issue=7 |pages=609–15 |date=April 2008 |pmid=18208572 |doi=10.1111/j.1365-2036.2008.03618.x |url=}}</ref> <ref name="pmid19719336">{{cite journal |vauthors=Curran MP, Robinson DM |title=Aprepitant: a review of its use in the prevention of nausea and vomiting |journal=Drugs |volume=69 |issue=13 |pages=1853–78 |date=2009 |pmid=19719336 |doi=10.2165/11203680-000000000-00000 |url=}}</ref> <ref name="pmid19444262">{{cite journal |vauthors=Chong K, Dhatariya K |title=A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant |journal=Nat Rev Endocrinol |volume=5 |issue=5 |pages=285–8 |date=May 2009 |pmid=19444262 |doi=10.1038/nrendo.2009.50 |url=}}</ref> | * [[NK-1]] [[Receptor]] [[Antagonist]] is used in acute as well as delayed chemotherapy-induced nausea and vomiting. It has also been used in gastroparesis-associated nausea and vomiting. Eg., [[Aprepitant]] 80–125 mg every 24 hours oral. <ref name="pmid18208572">{{cite journal |vauthors=Madsen JL, Fuglsang S |title=A randomized, placebo-controlled, crossover, double-blind trial of the NK1 receptor antagonist aprepitant on gastrointestinal motor function in healthy humans |journal=Aliment Pharmacol Ther |volume=27 |issue=7 |pages=609–15 |date=April 2008 |pmid=18208572 |doi=10.1111/j.1365-2036.2008.03618.x |url=}}</ref> <ref name="pmid19719336">{{cite journal |vauthors=Curran MP, Robinson DM |title=Aprepitant: a review of its use in the prevention of nausea and vomiting |journal=Drugs |volume=69 |issue=13 |pages=1853–78 |date=2009 |pmid=19719336 |doi=10.2165/11203680-000000000-00000 |url=}}</ref> <ref name="pmid19444262">{{cite journal |vauthors=Chong K, Dhatariya K |title=A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant |journal=Nat Rev Endocrinol |volume=5 |issue=5 |pages=285–8 |date=May 2009 |pmid=19444262 |doi=10.1038/nrendo.2009.50 |url=}}</ref> | ||
===Prokinetics=== | ===Prokinetics=== | ||
*Prokinetic agents are used for only prokinetic activity (eg, Erythromycin) or both prokinetic and antiemetic activity (eg, Benzamides like Metoclopramide and Domperidone are shown to be efficacious in chemotherapy induced vomiting and gastroparesis). Metoclopramide 10–20 mg every 6–8 hours Oral, IM or IV, Domperidone 10mg every 8–24 hours oral, Erythromycin 250–500mg every 8 hours oral or IV. <ref name="pmid23201066">{{cite journal |vauthors=Javid FA, Bulmer DC, Broad J, Aziz Q, Dukes GE, Sanger GJ |title=Anti-emetic and emetic effects of erythromycin in Suncus murinus: role of vagal nerve activation, gastric motility stimulation and motilin receptors |journal=Eur J Pharmacol |volume=699 |issue=1-3 |pages=48–54 |date=January 2013 |pmid=23201066 |doi=10.1016/j.ejphar.2012.11.035 |url=}}</ref> <ref name="pmid1612359">{{cite journal |vauthors=Tack J, Janssens J, Vantrappen G, Peeters T, Annese V, Depoortere I, Muls E, Bouillon R |title=Effect of erythromycin on gastric motility in controls and in diabetic gastroparesis |journal=Gastroenterology |volume=103 |issue=1 |pages=72–9 |date=July 1992 |pmid=1612359 |doi=10.1016/0016-5085(92)91097-n |url=}}</ref> | *[[Prokinetic]] agents are used for only prokinetic activity (eg, [[Erythromycin]]) or both prokinetic and [[antiemetic]] activity (eg, [[Benzamides]] like [[Metoclopramide]] and [[Domperidone]] are shown to be efficacious in chemotherapy induced vomiting and [[gastroparesis]]). [[Metoclopramide]] 10–20 mg every 6–8 hours Oral, IM or IV, [[Domperidone]] 10mg every 8–24 hours oral, [[Erythromycin]] 250–500mg every 8 hours oral or IV. <ref name="pmid23201066">{{cite journal |vauthors=Javid FA, Bulmer DC, Broad J, Aziz Q, Dukes GE, Sanger GJ |title=Anti-emetic and emetic effects of erythromycin in Suncus murinus: role of vagal nerve activation, gastric motility stimulation and motilin receptors |journal=Eur J Pharmacol |volume=699 |issue=1-3 |pages=48–54 |date=January 2013 |pmid=23201066 |doi=10.1016/j.ejphar.2012.11.035 |url=}}</ref> <ref name="pmid1612359">{{cite journal |vauthors=Tack J, Janssens J, Vantrappen G, Peeters T, Annese V, Depoortere I, Muls E, Bouillon R |title=Effect of erythromycin on gastric motility in controls and in diabetic gastroparesis |journal=Gastroenterology |volume=103 |issue=1 |pages=72–9 |date=July 1992 |pmid=1612359 |doi=10.1016/0016-5085(92)91097-n |url=}}</ref> | ||
===Miscellaneous therapy=== | ===Miscellaneous therapy=== | ||
* Novel and non-traditional therapies for nausea and vomiting include Tricyclic antidepressants (TCAs), Gabapentin and Olanzapine. Gabapentin is shown effective in life-threatening refractory emesis following posterior fossa surgery. TCAs (Amitriptyline, Nortriptyline, Doxepin, Desipramine, Imipramine) 10–100 mg/day oral, Gabapentin 300–900 mg three times daily oral, Olanzapine 5–10 mg/day oral. <ref name="pmid9753257">{{cite journal |vauthors=Prakash C, Lustman PJ, Freedland KE, Clouse RE |title=Tricyclic antidepressants for functional nausea and vomiting: clinical outcome in 37 patients |journal=Dig Dis Sci |volume=43 |issue=9 |pages=1951–6 |date=September 1998 |pmid=9753257 |doi=10.1023/a:1018878324327 |url=}}</ref> <ref name="pmid24668130">{{cite journal |vauthors=Guttuso T |title=Gabapentin's anti-nausea and anti-emetic effects: a review |journal=Exp Brain Res |volume=232 |issue=8 |pages=2535–9 |date=August 2014 |pmid=24668130 |doi=10.1007/s00221-014-3905-1 |url=}}</ref> <ref name="pmid15796394">{{cite journal |vauthors=Guttuso T, Vitticore P, Holloway RG |title=Responsiveness of life-threatening refractory emesis to gabapentin-scopolamine therapy following posterior fossa surgery. Case report |journal=J Neurosurg |volume=102 |issue=3 |pages=547–9 |date=March 2005 |pmid=15796394 |doi=10.3171/jns.2005.102.3.0547 |url=}}</ref> <ref name="pmid15700131">{{cite journal |vauthors=Navari RM, Einhorn LH, Passik SD, Loehrer PJ, Johnson C, Mayer ML, McClean J, Vinson J, Pletcher W |title=A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study |journal=Support Care Cancer |volume=13 |issue=7 |pages=529–34 |date=July 2005 |pmid=15700131 |doi=10.1007/s00520-004-0755-6 |url=}}</ref> <ref name="pmid15493359">{{cite journal |vauthors=Passik SD, Navari RM, Jung SH, Nagy C, Vinson J, Kirsh KL, Loehrer P |title=A phase I trial of olanzapine (Zyprexa) for the prevention of delayed emesis in cancer patients: a Hoosier Oncology Group study |journal=Cancer Invest |volume=22 |issue=3 |pages=383–8 |date=2004 |pmid=15493359 |doi=10.1081/cnv-200029066 |url=}}</ref> | * [[Novel]] and [[non-traditional]] therapies for nausea and vomiting include [[Tricyclic antidepressants]] ([[TCAs]]), [[Gabapentin]] and [[Olanzapine]]. [[Gabapentin]] is shown effective in life-threatening [[refractory]] [[emesis]] following [[posterior fossa]] [[surgery]]. TCAs ([[Amitriptyline]], [[Nortriptyline]], [[Doxepin]], [[Desipramine]], [[Imipramine]]) 10–100 mg/day oral, [[Gabapentin]] 300–900 mg three times daily oral, [[Olanzapine]] 5–10 mg/day oral. <ref name="pmid9753257">{{cite journal |vauthors=Prakash C, Lustman PJ, Freedland KE, Clouse RE |title=Tricyclic antidepressants for functional nausea and vomiting: clinical outcome in 37 patients |journal=Dig Dis Sci |volume=43 |issue=9 |pages=1951–6 |date=September 1998 |pmid=9753257 |doi=10.1023/a:1018878324327 |url=}}</ref> <ref name="pmid24668130">{{cite journal |vauthors=Guttuso T |title=Gabapentin's anti-nausea and anti-emetic effects: a review |journal=Exp Brain Res |volume=232 |issue=8 |pages=2535–9 |date=August 2014 |pmid=24668130 |doi=10.1007/s00221-014-3905-1 |url=}}</ref> <ref name="pmid15796394">{{cite journal |vauthors=Guttuso T, Vitticore P, Holloway RG |title=Responsiveness of life-threatening refractory emesis to gabapentin-scopolamine therapy following posterior fossa surgery. Case report |journal=J Neurosurg |volume=102 |issue=3 |pages=547–9 |date=March 2005 |pmid=15796394 |doi=10.3171/jns.2005.102.3.0547 |url=}}</ref> <ref name="pmid15700131">{{cite journal |vauthors=Navari RM, Einhorn LH, Passik SD, Loehrer PJ, Johnson C, Mayer ML, McClean J, Vinson J, Pletcher W |title=A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study |journal=Support Care Cancer |volume=13 |issue=7 |pages=529–34 |date=July 2005 |pmid=15700131 |doi=10.1007/s00520-004-0755-6 |url=}}</ref> <ref name="pmid15493359">{{cite journal |vauthors=Passik SD, Navari RM, Jung SH, Nagy C, Vinson J, Kirsh KL, Loehrer P |title=A phase I trial of olanzapine (Zyprexa) for the prevention of delayed emesis in cancer patients: a Hoosier Oncology Group study |journal=Cancer Invest |volume=22 |issue=3 |pages=383–8 |date=2004 |pmid=15493359 |doi=10.1081/cnv-200029066 |url=}}</ref> | ||
* Ginger has some efficacy to reduce postoperative nausea and vomiting, morning sickness and motion sickness. <ref name="pmid10793599">{{cite journal |vauthors=Ernst E, Pittler MH |title=Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials |journal=Br J Anaesth |volume=84 |issue=3 |pages=367–71 |date=March 2000 |pmid=10793599 |doi=10.1093/oxfordjournals.bja.a013442 |url=}}</ref> <ref name="pmid12233808">{{cite journal |vauthors=Keating A, Chez RA |title=Ginger syrup as an antiemetic in early pregnancy |journal=Altern Ther Health Med |volume=8 |issue=5 |pages=89–91 |date=2002 |pmid=12233808 |doi= |url=}}</ref> | * [[Ginger]] has some [[efficacy]] to reduce postoperative [[nausea]] and [[vomiting]], [[morning sickness]] and [[motion sickness]]. <ref name="pmid10793599">{{cite journal |vauthors=Ernst E, Pittler MH |title=Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials |journal=Br J Anaesth |volume=84 |issue=3 |pages=367–71 |date=March 2000 |pmid=10793599 |doi=10.1093/oxfordjournals.bja.a013442 |url=}}</ref> <ref name="pmid12233808">{{cite journal |vauthors=Keating A, Chez RA |title=Ginger syrup as an antiemetic in early pregnancy |journal=Altern Ther Health Med |volume=8 |issue=5 |pages=89–91 |date=2002 |pmid=12233808 |doi= |url=}}</ref> | ||
* Gastric electric stimulation(GES) is a surgical procedure used in refractory gastroparesis. <ref name="pmid19719511">{{cite journal |vauthors=McCallum RW, Dusing RW, Sarosiek I, Cocjin J, Forster J, Lin Z |title=Mechanisms of symptomatic improvement after gastric electrical stimulation in gastroparetic patients |journal=Neurogastroenterol Motil |volume=22 |issue=2 |pages=161–7, e50–1 |date=February 2010 |pmid=19719511 |doi=10.1111/j.1365-2982.2009.01389.x |url=}}</ref> | * [[Gastric electric stimulation]]([[GES]]) is a surgical procedure used in [[refractory]] [[gastroparesis]]. <ref name="pmid19719511">{{cite journal |vauthors=McCallum RW, Dusing RW, Sarosiek I, Cocjin J, Forster J, Lin Z |title=Mechanisms of symptomatic improvement after gastric electrical stimulation in gastroparetic patients |journal=Neurogastroenterol Motil |volume=22 |issue=2 |pages=161–7, e50–1 |date=February 2010 |pmid=19719511 |doi=10.1111/j.1365-2982.2009.01389.x |url=}}</ref> | ||
* Transcutaneous electrical nerve stimulation (TENS) with a wrist band is used to control symptoms postoperatively. <ref name="pmid32913634">{{cite journal |vauthors=Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H |title=Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review |journal=F1000Res |volume=9 |issue= |pages= |date=2020 |pmid=32913634 |pmc=7429924 |doi=10.12688/f1000research.21832.1 |url=}}</ref> | * [[Transcutaneous electrical nerve stimulation]] ([[TENS]]) with a wrist band is used to control symptoms postoperatively. <ref name="pmid32913634">{{cite journal |vauthors=Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H |title=Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review |journal=F1000Res |volume=9 |issue= |pages= |date=2020 |pmid=32913634 |pmc=7429924 |doi=10.12688/f1000research.21832.1 |url=}}</ref> | ||
* Alternative approaches include hypnosis, acupressure and acupuncture. <ref name="pmid10971166">{{cite journal |vauthors=Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O |title=Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy |journal=Oncology |volume=59 |issue=2 |pages=100–4 |date=August 2000 |pmid=10971166 |doi=10.1159/000012144 |url=}}</ref> <ref name="pmid19370583">{{cite journal |vauthors=Lee A, Fan LT |title=Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD003281 |date=April 2009 |pmid=19370583 |pmc=3113464 |doi=10.1002/14651858.CD003281.pub3 |url=}}</ref> | * Alternative approaches include [[hypnosis]], [[acupressure]] and [[acupuncture]]. <ref name="pmid10971166">{{cite journal |vauthors=Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O |title=Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy |journal=Oncology |volume=59 |issue=2 |pages=100–4 |date=August 2000 |pmid=10971166 |doi=10.1159/000012144 |url=}}</ref> <ref name="pmid19370583">{{cite journal |vauthors=Lee A, Fan LT |title=Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD003281 |date=April 2009 |pmid=19370583 |pmc=3113464 |doi=10.1002/14651858.CD003281.pub3 |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 03:11, 21 January 2021
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Nausea and vomiting Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: {{VVS}
Overview
Mainstay of treatment of nausea and vomiting is correcting any electrolyte imbalance, dehydration, malnutrition, and suppression of symptoms while evaluating and treating the underlying cause. Dietary recommendations include a low-fat, low-fiber diet with frequent small meals if able to tolerate oral intake. Liquid diet is recommended in case solid diet is not well tolerated. Medical therapy involves two groups of drugs i.e., antiemetics and prokinetics. Antiemetics suppress nausea and vomiting and typically act centrally. Prokinetics modulate gastrointestinal motility.
Medical Therapy
- Mainstay of treatment of nausea and vomiting is correcting any electrolyte imbalance, dehydration, malnutrition, and suppression of symptoms while evaluating and treating the underlying cause. [1]
- Dietary recommendations include a low-fat, low-fiber diet with frequent small meals if able to tolerate oral intake. Liquid diet is recommended in case solid diet is not well tolerated. [2]
- Medical therapy involves two groups of drugs i.e., antiemetics and prokinetics. Antiemetics suppress nausea and vomiting and typically act centrally. Prokinetics modulate gastrointestinal motility.
Antiemetics
- Benzodiazepines are used for anticipatory nausea and postoperative nausea and vomiting. Eg., Lorazepam 0.5-2mg oral, SL (sublingual) or IM (intramuscular), Alprazolam 0.25-1mg oral or IV (intravenous). [3]
- Serotonin 5-HT3 antagonists are used in postoperative, post-radiation and chemotherapy induced nausea and vomiting. Eg., Ondansetron 4-8mg oral or IV, Granisetron 1-2 mg every 4-8 hours or 0.075mg-0.25mg every 24 hours oral or IV. [1]
- Antihistamines are used in motion sickness and labrythitis. Eg., Meclizine 25-50mg every 24 hours oral, Diphenhydramine, Cyclizine, Hydroxazine 25-50mg every 6-8 hours, 25–75 mg every 8 hours, 25–50 mg every 4–6 hours, 25–100 mg every 6–8 hours oral, IM or IV. [2] [4]
- Anticholinergic agents are used in motion sickness. Eg., Scopolamine 0.3–0.6 mg every 24 hours SL, IV, IM or transdermal. [5] [6]
- Phenothiazines are antidopaminergics which are effective for migraine, motion sickness, vertigo, postoperative and chemotherapy induced nausea and vomiting. Eg., Prochlorperazine, Promethazine, Chlorpromazine, Perphenazine 5–10 mg every 6–8 hours, 12.5 –25 mg every 4–6 hours, 10–25 mg every 4–6 hours, 4–8 mg every 8–12 hours Oral, IV or IM. [7] [8]
- Droperidol is a Butyrophenone and a restricted drug used for postoperative and chemotherapy induced nausea and vomiting, 0.625–1.25 mg every 24hours IM or IV [5]
- Cannabinoids are used for chemotherapy induced nausea and vomiting. Eg., Dronabinol, Nabilone 2.5–10 mg every 6–8 hours, 1–2 mg every 8–12 hours oral. [8] [9]
- Corticosteroids are used for acute or delayed chemotherapy induced or postoperative nausea and vomiting. Eg., Dexamethasone 4–8 mg every 4–6 hours Oral, IM or IV. [8] [10]
- NK-1 Receptor Antagonist is used in acute as well as delayed chemotherapy-induced nausea and vomiting. It has also been used in gastroparesis-associated nausea and vomiting. Eg., Aprepitant 80–125 mg every 24 hours oral. [11] [12] [13]
Prokinetics
- Prokinetic agents are used for only prokinetic activity (eg, Erythromycin) or both prokinetic and antiemetic activity (eg, Benzamides like Metoclopramide and Domperidone are shown to be efficacious in chemotherapy induced vomiting and gastroparesis). Metoclopramide 10–20 mg every 6–8 hours Oral, IM or IV, Domperidone 10mg every 8–24 hours oral, Erythromycin 250–500mg every 8 hours oral or IV. [14] [15]
Miscellaneous therapy
- Novel and non-traditional therapies for nausea and vomiting include Tricyclic antidepressants (TCAs), Gabapentin and Olanzapine. Gabapentin is shown effective in life-threatening refractory emesis following posterior fossa surgery. TCAs (Amitriptyline, Nortriptyline, Doxepin, Desipramine, Imipramine) 10–100 mg/day oral, Gabapentin 300–900 mg three times daily oral, Olanzapine 5–10 mg/day oral. [16] [17] [18] [19] [20]
- Ginger has some efficacy to reduce postoperative nausea and vomiting, morning sickness and motion sickness. [21] [22]
- Gastric electric stimulation(GES) is a surgical procedure used in refractory gastroparesis. [23]
- Transcutaneous electrical nerve stimulation (TENS) with a wrist band is used to control symptoms postoperatively. [24]
- Alternative approaches include hypnosis, acupressure and acupuncture. [25] [26]
References
- ↑ 1.0 1.1 Hasler WL, Chey WD (December 2003). "Nausea and vomiting". Gastroenterology. 125 (6): 1860–7. doi:10.1053/j.gastro.2003.09.040. PMID 14724837.
- ↑ 2.0 2.1 Singh P, Yoon SS, Kuo B (January 2016). "Nausea: a review of pathophysiology and therapeutics". Therap Adv Gastroenterol. 9 (1): 98–112. doi:10.1177/1756283X15618131. PMC 4699282. PMID 26770271.
- ↑ Di Florio T, Goucke R (August 1993). "Reduction of dopamine release and postoperative emesis by benzodiazepines". Br J Anaesth. 71 (2): 325. doi:10.1093/bja/71.2.325. PMID 8123420.
- ↑ Flake ZA, Scalley RD, Bailey AG (March 2004). "Practical selection of antiemetics". Am Fam Physician. 69 (5): 1169–74. PMID 15023018.
- ↑ 5.0 5.1 Quigley EM, Hasler WL, Parkman HP (January 2001). "AGA technical review on nausea and vomiting". Gastroenterology. 120 (1): 263–86. doi:10.1053/gast.2001.20516. PMID 11208736.
- ↑ Golding JF, Stott JR (June 1997). "Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate". Br J Clin Pharmacol. 43 (6): 633–7. doi:10.1046/j.1365-2125.1997.00606.x. PMC 2042789. PMID 9205824.
- ↑ Sanger GJ, Andrews PL (October 2006). "Treatment of nausea and vomiting: gaps in our knowledge". Auton Neurosci. 129 (1–2): 3–16. doi:10.1016/j.autneu.2006.07.009. PMID 16934536.
- ↑ 8.0 8.1 8.2 Chepyala P, Olden KW (April 2008). "Nausea and vomiting". Curr Treat Options Gastroenterol. 11 (2): 135–44. doi:10.1007/s11938-008-0026-6. PMID 18321441.
- ↑ Herman TS, Einhorn LH, Jones SE, Nagy C, Chester AB, Dean JC, Furnas B, Williams SD, Leigh SA, Dorr RT, Moon TE (June 1979). "Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy". N Engl J Med. 300 (23): 1295–7. doi:10.1056/NEJM197906073002302. PMID 375088.
- ↑ Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N (June 2004). "A factorial trial of six interventions for the prevention of postoperative nausea and vomiting". N Engl J Med. 350 (24): 2441–51. doi:10.1056/NEJMoa032196. PMC 1307533. PMID 15190136.
- ↑ Madsen JL, Fuglsang S (April 2008). "A randomized, placebo-controlled, crossover, double-blind trial of the NK1 receptor antagonist aprepitant on gastrointestinal motor function in healthy humans". Aliment Pharmacol Ther. 27 (7): 609–15. doi:10.1111/j.1365-2036.2008.03618.x. PMID 18208572.
- ↑ Curran MP, Robinson DM (2009). "Aprepitant: a review of its use in the prevention of nausea and vomiting". Drugs. 69 (13): 1853–78. doi:10.2165/11203680-000000000-00000. PMID 19719336.
- ↑ Chong K, Dhatariya K (May 2009). "A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant". Nat Rev Endocrinol. 5 (5): 285–8. doi:10.1038/nrendo.2009.50. PMID 19444262.
- ↑ Javid FA, Bulmer DC, Broad J, Aziz Q, Dukes GE, Sanger GJ (January 2013). "Anti-emetic and emetic effects of erythromycin in Suncus murinus: role of vagal nerve activation, gastric motility stimulation and motilin receptors". Eur J Pharmacol. 699 (1–3): 48–54. doi:10.1016/j.ejphar.2012.11.035. PMID 23201066.
- ↑ Tack J, Janssens J, Vantrappen G, Peeters T, Annese V, Depoortere I, Muls E, Bouillon R (July 1992). "Effect of erythromycin on gastric motility in controls and in diabetic gastroparesis". Gastroenterology. 103 (1): 72–9. doi:10.1016/0016-5085(92)91097-n. PMID 1612359.
- ↑ Prakash C, Lustman PJ, Freedland KE, Clouse RE (September 1998). "Tricyclic antidepressants for functional nausea and vomiting: clinical outcome in 37 patients". Dig Dis Sci. 43 (9): 1951–6. doi:10.1023/a:1018878324327. PMID 9753257.
- ↑ Guttuso T (August 2014). "Gabapentin's anti-nausea and anti-emetic effects: a review". Exp Brain Res. 232 (8): 2535–9. doi:10.1007/s00221-014-3905-1. PMID 24668130.
- ↑ Guttuso T, Vitticore P, Holloway RG (March 2005). "Responsiveness of life-threatening refractory emesis to gabapentin-scopolamine therapy following posterior fossa surgery. Case report". J Neurosurg. 102 (3): 547–9. doi:10.3171/jns.2005.102.3.0547. PMID 15796394.
- ↑ Navari RM, Einhorn LH, Passik SD, Loehrer PJ, Johnson C, Mayer ML, McClean J, Vinson J, Pletcher W (July 2005). "A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study". Support Care Cancer. 13 (7): 529–34. doi:10.1007/s00520-004-0755-6. PMID 15700131.
- ↑ Passik SD, Navari RM, Jung SH, Nagy C, Vinson J, Kirsh KL, Loehrer P (2004). "A phase I trial of olanzapine (Zyprexa) for the prevention of delayed emesis in cancer patients: a Hoosier Oncology Group study". Cancer Invest. 22 (3): 383–8. doi:10.1081/cnv-200029066. PMID 15493359.
- ↑ Ernst E, Pittler MH (March 2000). "Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials". Br J Anaesth. 84 (3): 367–71. doi:10.1093/oxfordjournals.bja.a013442. PMID 10793599.
- ↑ Keating A, Chez RA (2002). "Ginger syrup as an antiemetic in early pregnancy". Altern Ther Health Med. 8 (5): 89–91. PMID 12233808.
- ↑ McCallum RW, Dusing RW, Sarosiek I, Cocjin J, Forster J, Lin Z (February 2010). "Mechanisms of symptomatic improvement after gastric electrical stimulation in gastroparetic patients". Neurogastroenterol Motil. 22 (2): 161–7, e50–1. doi:10.1111/j.1365-2982.2009.01389.x. PMID 19719511.
- ↑ Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H (2020). "Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review". F1000Res. 9. doi:10.12688/f1000research.21832.1. PMC 7429924 Check
|pmc=value (help). PMID 32913634 Check|pmid=value (help). - ↑ Marchioro G, Azzarello G, Viviani F, Barbato F, Pavanetto M, Rosetti F, Pappagallo GL, Vinante O (August 2000). "Hypnosis in the treatment of anticipatory nausea and vomiting in patients receiving cancer chemotherapy". Oncology. 59 (2): 100–4. doi:10.1159/000012144. PMID 10971166.
- ↑ Lee A, Fan LT (April 2009). "Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting". Cochrane Database Syst Rev (2): CD003281. doi:10.1002/14651858.CD003281.pub3. PMC 3113464. PMID 19370583.