What is the role of corticosteroids (steroids) in managing hyperemesis (excessive vomiting) and nausea in non-pregnant individuals?

From the Guidelines

Corticosteroids should not be used as a first-line treatment for hyperemesis and nausea in non-pregnant individuals, but may be considered for severe, refractory cases that haven't responded to other treatments, as evidenced by a study published in the World Journal of Emergency Surgery 1. When managing hyperemesis and nausea in non-pregnant individuals, the following approach is recommended:

• Start with antiemetics like ondansetron (4-8 mg orally every 8 hours) or promethazine (12.5-25 mg orally every 4-6 hours), as these have been shown to be effective in reducing nausea and vomiting 1.
• If these are ineffective, try metoclopramide (10 mg orally or IV every 6-8 hours) or prochlorperazine (5-10 mg orally every 6-8 hours), which have also been found to be effective in managing nausea and vomiting 2.
• For persistent symptoms, add an H2 blocker like famotidine (20 mg orally twice daily) or a proton pump inhibitor like omeprazole (20 mg orally once daily), as these can help reduce gastric acid production and alleviate symptoms. Only consider steroids like dexamethasone (4-8 mg IV or orally daily) for severe, refractory cases that haven't responded to other treatments, as they have been found to be effective in combination with other antiemetics in reducing opioid-induced nausea and vomiting 2. It is essential to limit steroid use to short courses (3-5 days) due to potential side effects, such as immunosuppression and increased risk of adverse events 1. Always investigate and address the underlying cause of nausea and hyperemesis in non-pregnant individuals, as this can help guide treatment and improve outcomes.

From the Research

Role of Corticosteroids in Managing Hyperemesis and Nausea

• The use of corticosteroids in managing hyperemesis and nausea in non-pregnant individuals is not directly addressed in the provided studies, as they primarily focus on pregnant women 3, 4, 5, 6, 7.
• However, in the context of hyperemesis gravidarum, corticosteroids have been explored as a potential treatment option for severe cases 3, 4, 5.
• A study found that corticosteroids may be associated with benefit in severe cases of hyperemesis gravidarum, with improvements seen in all corticosteroid groups compared to placebo or other treatments 3.
• Another study reported that the addition of parenteral and oral corticosteroids to the treatment of women with hyperemesis gravidarum did not reduce the need for rehospitalization later in pregnancy 4.
• Uncontrolled data have suggested a beneficial effect of corticosteroids in women with severe hyperemesis gravidarum, although more research is needed to confirm this 5.

Limitations and Gaps in Research

• The provided studies primarily focus on pregnant women, and there is a lack of research on the use of corticosteroids in managing hyperemesis and nausea in non-pregnant individuals.
• The quality of evidence for the use of corticosteroids in hyperemesis gravidarum is generally low, with limited and inconsistent findings across studies 3, 4, 5, 7.
• Further research is needed to fully understand the potential benefits and risks of using corticosteroids in managing hyperemesis and nausea, particularly in non-pregnant individuals.