What to do for nausea after stopping Lexapro (escitalopram) and trazodone?

From the Guidelines

For nausea after stopping Lexapro (escitalopram) and trazodone, try taking ondansetron (4-8 mg twice or three times a day) or granisetron (1 mg twice a day) as these medications have shown efficacy in improving nausea and vomiting symptoms 1. When considering treatment options, it's essential to prioritize medications that have been studied in the context of gastroparesis or have a mechanism of action that can help alleviate nausea and vomiting.

• Ondansetron and granisetron are 5-Hydroxytryptamine3 (5-HT3) receptor antagonists that block serotonin receptors in the chemoreceptor trigger zone and inhibit vagal afferents, thereby improving nausea and vomiting 1.
• Neurokinin (NK-1) receptor antagonists, such as aprepitant, have also shown promise in improving nausea and vomiting symptoms, although their use may be limited by cost and availability 1. In addition to medication, it's crucial to address lifestyle factors that can exacerbate nausea, such as:
• Staying hydrated with small sips of clear fluids
• Eating bland foods in small portions (like crackers, toast, or rice)
• Avoiding spicy, greasy, or strong-smelling foods
• Resting in a cool, quiet environment
• Trying deep breathing exercises These symptoms are likely antidepressant discontinuation syndrome, which occurs because the brain is adjusting to the absence of these medications that affect serotonin levels. If nausea is severe, persists beyond 1-2 weeks, includes vomiting that prevents keeping fluids down, or is accompanied by high fever or severe headache, contact a healthcare provider immediately. Never stop antidepressants abruptly; always taper under medical supervision to minimize withdrawal symptoms. It's also important to note that medications like metoclopramide, domperidone, and phenothiazine antipsychotics may be considered in certain cases, but their use should be guided by a healthcare provider due to potential side effects and interactions 1.

From the FDA Drug Label

Stopping Escitalopram tablets too quickly may cause serious symptoms including: • anxiety, irritability, high or low mood, feeling restless or changes in sleep habits • headache, sweating, nausea, dizziness • electric shock-like sensations, shaking, confusion

The patient is experiencing nausea after stopping Lexapro (escitalopram) and trazodone. Nausea is a possible symptom of discontinuation of escitalopram. To manage this symptom, a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur, resuming the previously prescribed dose may be considered, and then the physician may continue decreasing the dose but at a more gradual rate 2.

From the Research

Nausea After Stopping Lexapro and Trazodone

• The patient's symptoms of nausea after stopping Lexapro (escitalopram) and trazodone may be related to withdrawal effects or other underlying conditions.
• There is limited research directly addressing nausea after stopping these specific medications, but studies on nausea and vomiting in various contexts may provide some insights.

Antiemetic Options

• Ondansetron and metoclopramide are commonly used antiemetics for nausea and vomiting, as seen in studies 3, 4, 5.
• A study comparing ondansetron and metoclopramide for severe nausea and vomiting in pregnancy found that ondansetron had a more favorable effect in controlling vomiting 5.
• Another study compared tropisetron and metoclopramide for treating nausea and vomiting in the emergency department, finding that tropisetron was associated with a lower vomiting rate 6.

Alternative Approaches

• Acupressure at the P6 point has been studied as a potential method for preventing nausea and vomiting, with some evidence suggesting its effectiveness 7.
• However, the patient's symptoms may require a different approach, and it is essential to consult a healthcare professional for personalized guidance.

Key Considerations

• The patient's symptoms should be evaluated by a healthcare professional to determine the underlying cause of nausea and to develop an appropriate treatment plan.
• Medications like ondansetron and metoclopramide may be considered for nausea and vomiting, but their effectiveness and potential side effects should be carefully evaluated 4, 5.