From the Research
For treating nausea associated with Avoidant/Restrictive Food Intake Disorder (ARFID), I recommend a multi-faceted approach combining medication and behavioral strategies, prioritizing the most recent and highest quality study available 1.
Medication Strategies
Medications that may help include low-dose ondansetron (Zofran) 4-8mg as needed before meals, promethazine (Phenergan) 12.5-25mg, or metoclopramide (Reglan) 5-10mg 30 minutes before eating. For longer-term management, consider mirtazapine (Remeron) 7.5-15mg at bedtime, which can reduce nausea while stimulating appetite.
Behavioral Interventions
Behavioral interventions are equally important and should include:
- Gradual exposure to feared foods
- Relaxation techniques before meals
- Keeping a food and symptom diary to identify specific triggers Cognitive behavioral therapy specifically targeting ARFID can address the anxiety component that often worsens nausea.
Mechanism of Action
The medications work through different mechanisms - antiemetics block signals to the vomiting center in the brain, while mirtazapine affects serotonin and histamine receptors to reduce nausea and increase appetite.
Multidisciplinary Approach
A multidisciplinary team including a psychiatrist, dietitian, and therapist typically provides the most effective treatment for ARFID-related nausea, as highlighted in the study assessing patients with ARFID presenting to a multi-disciplinary tertiary care program 2.
Clinical Features of ARFID
Understanding the clinical features of adult patients with ARFID, such as those presenting with fear of adverse consequences, is crucial for effective management, as noted in the study on clinical features of adult patients with ARFID 1.
Safety Profile
It's also important to consider the safety profile of medications, such as domperidone, which has been reviewed for its pharmacology and clinical applications in gastroenterology, offering an excellent safety profile for long-term administration 3.
Comparison of Antiemetic Use
Comparing the efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department nausea and vomiting, as done in a randomized controlled trial, provides valuable insights into the effectiveness of these medications 4.