From the Guidelines
Withdrawal from substances such as alcohol, opioids, benzodiazepines, nicotine, cannabis, and caffeine can cause nausea and vomiting. The most recent and highest quality study, 1, published in 2020, highlights that opioid withdrawal, in particular, causes significant gastrointestinal distress, including nausea, vomiting, and diarrhea. According to 1, the common signs and symptoms of opioid withdrawal include cravings, abdominal cramping, nausea, vomiting, diarrhea, agitation, anxiety, feelings of hopelessness, dysphoria, piloerection, and myalgias. Some key points to consider include:
- Alcohol withdrawal typically begins 6-24 hours after the last drink, with nausea and vomiting often accompanied by tremors, anxiety, and potentially seizures in severe cases, as noted in 1 and 1.
- Opioid withdrawal symptoms usually start 8-24 hours after the last dose, depending on the specific opioid, as mentioned in 1 and 1.
- Benzodiazepine withdrawal symptoms emerge more gradually, often 1-4 days after discontinuation, with nausea as a common symptom alongside anxiety and insomnia, as discussed in 1 and 1.
- Nicotine withdrawal can cause milder nausea, typically beginning within hours of the last cigarette, while cannabis withdrawal may produce nausea in heavy users, usually starting within 24-48 hours after cessation, as mentioned in the example answers.
- Caffeine withdrawal commonly causes nausea and headaches, typically beginning 12-24 hours after the last caffeine intake, as noted in the example answers. It's essential to prioritize the management of these symptoms to prevent complications and improve patient outcomes, as emphasized in 1 and 1.
From the FDA Drug Label
Symptoms reported following discontinuation of benzodiazepines include ... nausea, vomiting, diarrhea, loss of appetite, ... lacrimation, rhinorrhea, sneezing, yawning, excessive perspiration, goose-flesh, fever, chilliness alternating with flushing, restlessness, irritability, weakness, anxiety, depression, dilated pupils, tremors, tachycardia, abdominal cramps, body aches, involuntary twitching and kicking movements, anorexia, nausea, vomiting, diarrhea, intestinal spasms, and weight loss. The following adverse events were reported to occur by at least 5% of patients in a 4-week study ... Nausea14 (13.6%) ... Vomiting8 (7.8%)
Substance withdrawals that cause nausea and vomiting include:
- Benzodiazepine withdrawal 2
- Opiate withdrawal (e.g. heroin) 3
- Possibly buprenorphine withdrawal, as nausea and vomiting were reported as adverse events in patients taking buprenorphine 4
From the Research
Substance Withdrawals Causing Nausea and Vomiting
- Alcohol withdrawal is a common cause of nausea and vomiting, as it can lead to a range of symptoms including autonomic hyperactivity, agitation, and hallucinations 5, 6, 7, 8, 9
- Delirium tremens (DT), a severe form of alcohol withdrawal, can also cause nausea and vomiting, along with other symptoms such as changes in consciousness and cognitive and perceptual impairments 6, 7, 8
- Benzodiazepines, such as diazepam and lorazepam, are commonly used to treat alcohol withdrawal and DT, and can help alleviate symptoms including nausea and vomiting 5, 6, 7, 8, 9
- Other substances, such as barbiturates and adrenergic drugs, may also be used to treat alcohol withdrawal, but benzodiazepines are considered the gold standard due to their effectiveness and safety profile 9
Symptoms of Alcohol Withdrawal
- Nausea and vomiting are common symptoms of alcohol withdrawal, and can range from mild to severe 5, 6, 7, 8, 9
- Other symptoms of alcohol withdrawal may include:
Treatment of Alcohol Withdrawal
- Benzodiazepines, such as diazepam and lorazepam, are commonly used to treat alcohol withdrawal and DT 5, 6, 7, 8, 9
- Symptom-triggered regimes are often preferred over fixed tapering dose regimes, as they allow for more flexible and effective treatment 9
- Supportive care, including hydration and vitamin supplementation, is also essential in the management of alcohol withdrawal 9