From the Guidelines
Lupron (leuprolide acetate) is not recommended for the treatment of severe nausea of unknown cause. The most recent and highest quality study, published in 2022 1, suggests that nausea and vomiting should be managed with medications that target dopaminergic pathways, such as haloperidol, risperidone, metoclopramide, or prochlorperazine.
Treatment Approach
The standard approach for treating severe nausea of unknown cause should begin with a thorough diagnostic workup to identify the underlying cause. Initial treatment typically includes antiemetics such as:
- ondansetron (4-8 mg every 8 hours)
- promethazine (12.5-25 mg every 4-6 hours)
- metoclopramide (10 mg before meals and at bedtime)
Intravenous hydration may be necessary if dehydration is present.
Alternative Treatments
If nausea persists, alternative treatments can be considered, such as:
- adding a second agent (i.e., ondansetron) to control nausea and vomiting
- using octreotide for nausea and vomiting due to bowel obstruction caused by cancer
- considering cannabinoids, such as dronabinol or nabilone, for refractory chemotherapy-induced nausea and vomiting
Lupron Not Recommended
Lupron would not be appropriate for treating severe nausea of unknown cause, as it can actually cause nausea as a side effect and has no established mechanism for treating idiopathic nausea. The hormonal changes induced by Lupron could potentially worsen symptoms rather than improve them. A gastroenterology consultation would be more appropriate to determine the cause of persistent unexplained nausea and develop a targeted treatment plan, as suggested by studies published in 2019 1 and 2016 1.
From the Research
Treatment of Severe Nausea of Unknown Cause
- The use of Lupron (leuprolide acetate) for the treatment of severe nausea of unknown cause is supported by a study published in 1998 2.
- This study found that Lupron Depot 7.5 mg showed significant improvement in symptoms of abdominal pain and nausea compared to placebo (P < 0.001) in premenopausal women with functional bowel disease.
- The study used a double-blind, placebo-controlled, randomized design and assessed symptoms using daily diary cards and quality of life questionnaires.
- However, it is essential to note that this study focused on patients with functional bowel disease, and its results may not be directly applicable to other causes of severe nausea.
Alternative Treatment Options
- Other studies suggest that antiemetic drugs, such as serotonin antagonists (e.g., ondansetron) and dopamine antagonists (e.g., metoclopramide), can be effective in treating nausea and vomiting 3, 4, 5.
- These medications can be used to treat acute and chronic nausea and vomiting, but their effectiveness may vary depending on the underlying cause of the symptoms.
- A study published in 2020 found that serotonin and neurokinin antagonists, such as ondansetron and aprepitant, are highly effective in treating chemotherapy-induced nausea and vomiting 3.
- Another study published in 2010 found that ondansetron is as effective as promethazine in relieving nausea or vomiting in the emergency department and is not associated with sedation or akathisia 4.
Evaluation and Treatment Approach
- The evaluation and treatment of nausea and vomiting should be based on a careful history of related factors, including associated symptoms, timing of onset and duration of symptoms, and exacerbating or relieving factors 5, 6.
- A thoughtful discussion of benefits, side effects, and costs should guide the treatment approach, and pharmacologic therapy should be used for the shortest time necessary to control symptoms 5, 6.