Nausea and vomiting medical therapy

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}

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.
• 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.
• Various antiemetics are used with some more effective in specific etiologies.
• Benzodiazepines are used for anticipatory nausea and postoperative nausea nd vomiting. Eg., Lorazepam 0.5-2mg oral, sublingual or intramuscular, Alprazolam 0.25-1mg oral or IV.
• Serotonin antagonists are used in post-operative, 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.
• 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.
• Anticolenergic agents are used in motion sickness. Eg., Scopolamine 0.3–0.6 mg every 24 hours SL, IV, IM or transdermal.
• Phenothiazines are Antidopaminergics which are effective for migraine, motion sickness, vertigo, postoperative and chemotherapy induced nausea nd 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.
• Droperidol is a restricted drug used for postoperative and chemotherapy induced nausea and vomiting. Eg., 0.625–1.25 mg every 24hours IM or IV
• Cannabinoids are used for chemotherapy induced nausea nd vomiting. Eg., Dronabinol, Nabilone 2.5–10 mg every 6–8 hours, 1–2 mg every 8–12 hours oral.
• 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.
• Ginger has some efficacy to reduce post-operative nausea and vomiting, morning sickness and motion sickness.
• Alternative approaches include hypnosis, acupressure and acupuncture.

Treatment of Nausea

While short-term nausea and vomiting are generally harmless, they may sometimes indicate a more serious condition, such as Coeliac disease. When associated with prolonged vomiting, it may lead to dehydration and/or dangerous electrolyte imbalances.

There are several types of antiemetics, and researchers continue to look for more effective treatments. The main types used post operatively for surgical patients are ondansetron, dexamethasone, promethazine, diphenhydramine, and in small doses droperidol. Doxylamine is the drug of choice in pregnancy-related nausea. Anecdotally, another remedy used by recovery room nurses is to place an isopropyl alcohol swab under the patient's nose while he or she breathes through the nose. This may abate the nausea until the antiemetic medication takes effect. When ingested or inhaled, the chemical compound tetrahydrocannabinol has been shown to reduce nausea in some users. Also available are a variety of non-invasive (often untested) mechanical devices used to suppress nausea due to motion sickness.

The spice ginger is also used for centuries as a folk remedy to treat nausea, and recent research has supported this use.

Acute Pharmacotherapies

• Antiemetics: An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of some opioid analgesics and chemotherapy directed against cancer. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics, antihistamines, dopamine antagonists, serotonin antagonists and cannabinoids are used as anti-emetics.
• Anticholinergics