From the Guidelines
When experiencing vomiting, it is crucial to stop taking medications that can exacerbate nausea or worsen vomiting, such as ethionamide, prothionamide, PAS, and ethambutol, as well as antiretroviral drugs like zidovudine and protease inhibitors (PIs) 1.
Medications to Consider Stopping
- Ethionamide, prothionamide, and PAS, which are known to cause gastrointestinal side effects including vomiting 1
- Ethambutol, which may also contribute to vomiting 1
- Zidovudine and PIs, antiretroviral drugs that can worsen nausea and vomiting 1
Management of Vomiting
- If nausea and vomiting compromise drug delivery, consider splitting the dose of ethionamide or prothionamide or giving it at a separate time from other drugs 1
- For severe vomiting, regular monitoring of hydration status and serum potassium should be conducted, and community health workers or directly observed therapy supporters can be trained to provide oral rehydration solutions 1
Importance of Medical Consultation
- Never stop critical medications without medical consultation, as this can lead to under-treatment of the condition or medication toxicity 1
- Contact a healthcare provider promptly if unable to keep down essential medications to discuss alternative management strategies 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications to Consider Stopping When Experiencing Vomiting
- Opioid analgesics: Interactions with other drugs can lead to increased or decreased effects of opioids, and may exacerbate vomiting 2
- Metoclopramide: Can cause akathisia, and patients should be monitored for this adverse effect 3, 4
- Promethazine: May cause sedation and vascular damage upon intravenous administration, and should be used with caution 3
- Prochlorperazine: Can cause akathisia, and patients should be monitored for this adverse effect 3
- Medications that may be contributing to nausea and vomiting, such as antibiotics, cimetidine, carbamazepine, phenytoin, and barbiturates, should be reviewed and potentially stopped or adjusted 2
Considerations for Managing Nausea and Vomiting
- Nonpharmacologic management options, such as fluid and electrolyte replacement, small frequent meals, and avoidance of trigger foods, should be considered 5
- Antiemetic drugs, such as ondansetron, metoclopramide, and promethazine, can be effective in reducing symptoms of acute nausea and vomiting, but should be used for the shortest time necessary to control symptoms 3, 5, 4
- The underlying cause of nausea and vomiting should be identified and treated, if possible, to prevent further episodes 5, 6