From the Research
Antiemetics can be used to treat nausea and vomiting in patients with concussion, but they should be used cautiously and selectively, with ondansetron being the preferred first-line agent due to its minimal sedating effects and lack of masking of neurological symptoms. For mild to moderate symptoms, ondansetron (Zofran) 4-8 mg orally every 8 hours as needed is often the preferred choice 1. This is based on the most recent and highest quality study, which found that ondansetron has a high certainty of evidence for reducing vomiting, with a risk ratio of 0.55 (95% CI 0.51 to 0.60) compared to placebo 1.
Some key points to consider when using antiemetics in patients with concussion include:
- Using the shortest duration necessary, typically 24-72 hours, while monitoring for improvement in symptoms
- Avoiding medications that can cause excessive sedation or mask evolving neurological symptoms, such as phenothiazines, in the acute post-concussion period
- Advising patients that treating the nausea may help improve oral intake and prevent dehydration, which can worsen headaches and other concussion symptoms
- Being aware of the potential side effects of antiemetics, such as headache, constipation, and sedation, although the certainty of evidence for these outcomes is generally low to very low 1
Alternative options to ondansetron include promethazine (Phenergan) 12.5-25 mg orally, rectally, or IV every 4-6 hours as needed, or metoclopramide (Reglan) 5-10 mg orally or IV every 6 hours, although these medications may have more sedating effects and a higher risk of side effects 2, 3. Ultimately, the choice of antiemetic should be individualized based on the patient's specific needs and medical history.