From the Guidelines
For the management of nausea and vomiting, ondansetron (Zofran) 4-8mg every 8 hours is a safe and effective option, as supported by recent clinical guidelines and studies 1.
Medication Options
Other medications that can be considered for nausea and vomiting include:
- Granisetron 1 mg bid or granisetron patch 34.3 mg patch weekly 1
- Prochlorperazine 5–10 mg qid 1
- Metoclopramide 10mg three times daily, although it is essential to note that metoclopramide is the only FDA-approved medication for gastroparesis, and other agents are considered off-label use 1
- Aprepitant 80 mg/day, which has shown efficacy in improving nausea and vomiting in patients with gastroparesis 1
Important Considerations
When selecting a medication for nausea and vomiting, it is crucial to consider the underlying cause, severity, and potential side effects. Staying hydrated by taking small sips of clear fluids is also essential. If nausea persists beyond 24-48 hours, is accompanied by severe abdominal pain, high fever, or signs of dehydration, medical attention should be sought promptly.
Mechanisms of Action
These medications work through different mechanisms, such as:
- Antihistamines like dimenhydrinate blocking signals to the brain's vomiting center
- Ondansetron blocking serotonin receptors that trigger nausea
- Dopamine antagonists like metoclopramide inhibiting dopamine receptors in the brain It is essential to choose the most appropriate medication based on the individual patient's needs and medical history, as supported by the most recent and highest-quality studies 1.
From the FDA Drug Label
Ondansetron tablets are indicated for the prevention of nausea and vomiting associated with: highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. Ondansetron tablets are also indicated for the prevention of postoperative nausea and/or vomiting. The recommended dosage regimens for adult and pediatric patients are described in Table 1 and Table 2, respectively Metoclopramide Injection, USP is indicated for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy
Medications for Nausea and Vomiting:
- Ondansetron: can be taken safely for nausea and vomiting associated with highly emetogenic cancer chemotherapy, moderately emetogenic cancer chemotherapy, radiotherapy, and postoperative nausea and/or vomiting 2.
- Metoclopramide: can be taken safely for nausea and vomiting associated with emetogenic cancer chemotherapy, and postoperative nausea and vomiting 3.
Key Considerations:
- Dosage regimens vary depending on the indication, age, and severity of symptoms.
- Patients with severe hepatic impairment should not exceed a total daily dose of 8 mg of ondansetron.
- Metoclopramide should be used with caution in patients with renal or hepatic impairment.
From the Research
Medications for Nausea and Vomiting
The following medications can be taken safely for nausea and vomiting:
- Ondansetron: effective in controlling severe vomiting 4, 5, 6, 7
- Metoclopramide: can be used, but may have side effects such as akathisia 8, 4, 6, 7
- Promethazine: may be suitable when sedation is desirable, but has potential for vascular damage upon intravenous administration 8
- Prochlorperazine: can be used, but patients must be monitored for akathisia 8
- Droperidol: limited use due to potential for QT prolongation, but can be used in refractory cases 8
Comparison of Medications
Studies have compared the efficacy of these medications:
- Ondansetron was found to be more effective than metoclopramide in controlling severe vomiting 4
- Ondansetron and metoclopramide were found to have similar reductions in nausea severity, but ondansetron had a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication 6
- Ondansetron was found to be more effective than metoclopramide in the treatment of established postoperative nausea and vomiting 7
Safety and Efficacy
The safety and efficacy of these medications have been evaluated: