From the Research
For patients with cyclical vomiting syndrome (CVS) who don't respond to ondansetron, the next step typically involves trying aprepitant as a prophylactic medication, as it has been shown to be effective in reducing the frequency and severity of episodes in adults with refractory CVS 1. When considering treatment options for CVS, it's essential to take a biopsychosocial approach, addressing the physical, emotional, and environmental factors that contribute to the condition.
- The treatment approach should be individualized, as CVS has multiple potential triggers, including stress, hormonal changes, and mitochondrial dysfunction.
- Some patients may benefit from trying other antiemetic medications, such as promethazine, prochlorperazine, or metoclopramide, although the evidence for these is not as strong as for aprepitant in refractory cases.
- Low-dose tricyclic antidepressants like amitriptyline may also be considered for prevention of episodes, as they have been shown to be effective in reducing the frequency and severity of episodes in both adult and pediatric CVS patients 2.
- During acute episodes, some patients may benefit from sedation with benzodiazepines, such as lorazepam, combined with IV hydration.
- Anticonvulsants like topiramate or zonisamide may also be considered for prevention, although the evidence for these is limited.
- The association between CVS and migraines suggests that some patients may respond to anti-migraine medications like sumatriptan, reflecting the neurological connection between the two conditions 3, 2.
- It's crucial to address comorbid conditions, such as anxiety and depression, which are common in CVS patients, to improve overall patient outcomes 3.