What is the treatment for nausea and vomiting?

From the Guidelines

Treatment for nausea and vomiting should prioritize the use of 5-HT3 receptor antagonists, such as ondansetron or granisetron, due to their efficacy in blocking serotonin receptors in the chemoreceptor trigger zone and inhibiting vagal afferents, as supported by the most recent evidence 1.

Key Considerations

• For patients receiving moderately emetogenic chemotherapy, a two-drug combination of palonosetron and dexamethasone is recommended, with the option to substitute palonosetron with a first-generation 5-HT3 receptor antagonist like granisetron or ondansetron if necessary 1.
• In cases of medically refractory gastroparesis, domperidone, a dopamine D2-receptor antagonist, may be considered, although its use is limited by availability and cardiovascular safety concerns 1.
• Neurokinin (NK-1) receptor antagonists, such as aprepitant, have shown promise in improving nausea and vomiting, particularly in patients with idiopathic gastroparesis 1.

Treatment Options

• 5-HT3 receptor antagonists: ondansetron (Zofran) 4-8mg every 8 hours, granisetron (Kytril) 1-2mg every 8 hours 1
• Dopamine D2-receptor antagonists: domperidone 10mg three times a day, with caution due to potential cardiovascular side effects 1
• NK-1 receptor antagonists: aprepitant (Emend) 125mg/day, with consideration of cost and availability 1

Lifestyle Changes

• Stay hydrated by sipping clear fluids like water, ginger ale, or clear broth frequently
• Eat small, bland meals (toast, crackers, rice) and avoid spicy, greasy foods
• Consider ginger supplements (250mg four times daily) or peppermint tea for natural relief
• Rest in a cool, quiet environment and avoid strong odors
• Seek immediate medical attention if vomiting persists beyond 24 hours, is accompanied by severe abdominal pain, contains blood, or causes signs of dehydration (decreased urination, dizziness)

From the FDA Drug Label

In 2 randomized, double-blind, monotherapy trials, a single 24 mg oral dose of ondansetron tablets was superior to a relevant historical placebo control in the prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2 A randomized, placebo-controlled, double-blind trial was conducted in the US in 67 patients receiving a cyclophosphamide-based chemotherapy regimen containing doxorubicin The first 8 mg dose of ondansetron tablets was administered 30 minutes before the start of chemotherapy, with a subsequent dose 8 hours after the first dose, followed by 8 mg of ondansetron tablets twice a day for 2 days after the completion of chemotherapy. In two placebo-controlled, double-blind trials (one conducted in the US and the other outside the US) in 865 females undergoing inpatient surgical procedures, ondansetron tablets 16 mg as a single dose or placebo was administered one hour before the induction of general balanced anesthesia

The treatment for nausea and vomiting is ondansetron tablets, with the following dosages:

• A single 24 mg oral dose for the prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy 2
• 8 mg administered 30 minutes before the start of chemotherapy, with a subsequent dose 8 hours after the first dose, followed by 8 mg twice a day for 2 days after the completion of chemotherapy for moderately emetogenic chemotherapy 2
• 16 mg as a single dose for the prevention of postoperative nausea and vomiting in females undergoing inpatient surgical procedures 2

From the Research

Treatment Options for Nausea and Vomiting

• The treatment for nausea and vomiting can vary depending on the underlying cause and severity of symptoms 3, 4.
• Antiemetic agents, such as ondansetron, metoclopramide, and promethazine, are commonly used to treat nausea and vomiting in adults 3, 5.
• Ondansetron is a serotonin antagonist that has been shown to be safe and effective for the treatment of nausea and vomiting in various settings, including the emergency department and prehospital care 3, 6.
• Metoclopramide is a dopamine antagonist that can also be used to treat nausea and vomiting, but it may have more side effects than ondansetron, such as akathisia 3, 5.
• Nonpharmacologic management options, such as fluid and electrolyte replacement, small frequent meals, and avoidance of trigger foods, can also be effective in managing nausea and vomiting 4.

Specific Treatment Recommendations

• For acute nausea and vomiting, ondansetron or metoclopramide can be used as a first-line treatment 3, 5.
• For chronic nausea and vomiting, a careful history and physical examination are necessary to guide the initial evaluation and treatment 4.
• In children, ondansetron can be used to treat nausea and vomiting, especially in cases of dehydration or persistent vomiting 7.
• In cases of severe vomiting, decompression of the stomach with a nasogastric tube may be necessary, along with antiemetic medication 7.

Administration and Dosage

• Ondansetron can be administered intravenously, intramuscularly, or orally, with dosages ranging from 0.15 mg/kg to 4 mg 6, 7.
• Metoclopramide can be administered intravenously, with a dosage of 20 mg 5.
• The choice of administration route and dosage will depend on the individual patient's needs and the severity of their symptoms 3, 6, 5.