What is the treatment for dry heaves?

Treatment for Dry Heaves

Ondansetron (8 mg) is the recommended first-line treatment for dry heaves, as it effectively prevents and treats nausea and vomiting with significant efficacy compared to placebo. 1

Understanding Dry Heaves

Dry heaves (also called retching) are the body's attempt to vomit without producing any vomitus. This condition involves the same muscular contractions as vomiting but without expelling stomach contents.

Treatment Algorithm

First-line Treatments:

1. Antiemetic Medication

   • Ondansetron (Zofran): 8 mg orally every 8 hours as needed 1
     • For adults, administer 30 minutes before anticipated nausea triggers
     • Clinical trials show 61% of patients had complete resolution of vomiting episodes compared to only 6% with placebo (p<0.001)

2. Supportive Measures

   • Hydration:
     • Small, frequent sips of clear fluids
     • Oral rehydration solutions if dehydration is present
   • Dietary Modifications:
     • Avoid crunchy, spicy, acidic, or hot food/drinks 2
     • Small, frequent meals rather than large ones
     • Avoid foods with strong odors that may trigger nausea

For Persistent Dry Heaves:

If first-line treatment fails after 24 hours:

1. Increase Antiemetic Support:

   • Consider combination therapy with different antiemetic classes
   • For severe cases, intravenous hydration may be necessary

2. Address Underlying Causes:

   • Evaluate for potential triggers (medications, anxiety, gastroesophageal reflux)
   • Consider gastric acid suppression with proton pump inhibitors or H2 blockers if reflux is suspected 2

Special Considerations

For Dry Heaves Associated with Oral Dryness:

If dry heaves are accompanied by dry mouth:

1. For Mild Symptoms:

   • Non-pharmacological stimulation with sugar-free acidic candies, lozenges, or xylitol 2
   • Mechanical stimulation with sugar-free chewing gum
   • Saliva substitutes (oral sprays, gels, rinses)

2. For Moderate Symptoms:

   • Consider muscarinic agonists like pilocarpine if salivary gland function is moderately impaired 2
   • Maintain adequate hydration

Cautions and Contraindications

• Antimotility drugs (e.g., loperamide) should not be used as first-line treatment for dry heaves as they do not address the underlying mechanism 3
• Monitor for dehydration, especially in patients with persistent dry heaves
• Avoid medications that may worsen dry mouth if this is a contributing factor 4

Monitoring and Follow-up

• Assess response to treatment within 24 hours
• Evaluate hydration status regularly
• Consider further investigation if dry heaves persist beyond 48-72 hours despite appropriate treatment

When to Seek Immediate Medical Attention

• Persistent dry heaves unresponsive to treatment
• Signs of dehydration (decreased urine output, dizziness, extreme thirst)
• Abdominal pain or distention
• Fever or other signs of infection

The evidence strongly supports ondansetron as the most effective pharmacological intervention for dry heaves, with clinical trials demonstrating significant superiority over placebo in preventing vomiting episodes and reducing nausea severity 1.