What are the prescription treatments for motion sickness, mountain sickness, and other forms of vomiting?

Prescription Treatments for Different Forms of Vomiting in India

For most forms of vomiting, 5-HT3 receptor antagonists (particularly ondansetron) are the first-line treatment due to their superior efficacy and safety profile compared to other antiemetic medications. The choice of antiemetic should be based on the specific cause of vomiting, with different medications being more effective for different conditions.

Motion Sickness

First-line treatments:

• Scopolamine transdermal patch: Should be applied several hours before anticipated motion exposure 1
• Dimenhydrinate: FDA-approved for prevention and treatment of nausea, vomiting, or vertigo of motion sickness 2
• Promethazine: FDA-approved for active and prophylactic treatment of motion sickness 3

Administration guidelines:

• Scopolamine patch: Apply behind ear 4 hours before travel
• Dimenhydrinate: 50-100 mg orally every 4-6 hours as needed
• Promethazine: 25 mg orally 30-60 minutes before travel, then every 12 hours as needed

Mountain Sickness

First-line treatment:

• Ondansetron: 0.15 mg/kg parenteral or 0.2 mg/kg oral (maximum 4 mg) for acute mountain sickness 4

Supportive measures:

• Descent to lower altitude when possible
• Oxygen supplementation
• Adequate hydration

Chemotherapy-Induced Nausea and Vomiting

High emetic risk chemotherapy:

1. 3-drug combination: NK1 receptor antagonist + 5-HT3 receptor antagonist + dexamethasone 5
   • Day 1: Aprepitant 125 mg PO + Palonosetron 0.25 mg IV + Dexamethasone 12 mg PO/IV
   • Days 2-3: Aprepitant 80 mg PO + Dexamethasone 8 mg PO

Moderate emetic risk chemotherapy:

1. 2-drug combination: 5-HT3 receptor antagonist + dexamethasone 5
   • Palonosetron (preferred) 0.25 mg IV on day 1 + Dexamethasone 8 mg PO/IV
   • For select agents (carboplatin, cisplatin, doxorubicin, epirubicin, ifosfamide, irinotecan), add aprepitant

Low emetic risk chemotherapy:

• Single agent: Dexamethasone 8 mg PO/IV or 5-HT3 antagonist 5

Radiation-Induced Nausea and Vomiting

High-emetic risk radiation (total body, upper abdomen):

• 2-drug combination: 5-HT3 receptor antagonist + dexamethasone 5
  • Ondansetron 8 mg PO 2-3 times daily + Dexamethasone 4 mg PO daily

Moderate-emetic risk radiation:

• Single agent: 5-HT3 receptor antagonist 5
  • Ondansetron 8 mg PO before each fraction

Postoperative Nausea and Vomiting

• Ondansetron: 4 mg IV at end of surgery
• Dexamethasone: 4-8 mg IV single dose
• Promethazine: 12.5-25 mg IV/IM for rescue

Vertigo-Related Vomiting

Benign Paroxysmal Positional Vertigo (BPPV):

• Primary treatment: Canalith repositioning procedures (Epley maneuver) rather than medications 6
• Medications should NOT be used routinely for BPPV 6

Ménière's Disease:

• Acute episodes: Short-term vestibular suppressants 6
• Long-term management: Not recommended to use vestibular suppressants chronically 6

Vestibular Neuritis:

• Vestibular suppressants acutely and vestibular rehabilitation 6

Breakthrough/Refractory Vomiting

For patients who experience vomiting despite prophylaxis:

1. Olanzapine: Add to standard regimen if not already included 5
2. Alternative agents: NK1 receptor antagonist, lorazepam, dopamine receptor antagonist, or cannabinoids 5

Commonly Available Antiemetics in India

1. 5-HT3 Receptor Antagonists:

   • Ondansetron (Emeset, Ondem, Vomitrol)
   • Granisetron (Granicip, Neosetron)
   • Palonosetron (Paloxi)

2. NK1 Receptor Antagonists:

   • Aprepitant (Aprecap, Apremi)
   • Fosaprepitant (Fosaran)

3. Dopamine Antagonists:

   • Metoclopramide (Perinorm, Reglan)
   • Domperidone (Domstal, Motilium)
   • Prochlorperazine (Stemetil)

4. Antihistamines:

   • Promethazine (Phenergan)
   • Dimenhydrinate (Dramamine)

5. Anticholinergics:

   • Scopolamine (Hyoscine)

6. Corticosteroids:

   • Dexamethasone (Dexona, Decadron)

Important Considerations

• Elderly patients: Use lower doses to avoid adverse effects; higher risk of falls with untreated vestibular disorders 6
• Pregnancy: Most antiemetics should be used with caution; ondansetron is generally considered safer
• Pediatric patients: Ondansetron is effective for gastroenteritis-related vomiting in children 7
• Monitoring: Watch for QT prolongation with ondansetron and droperidol
• Akathisia: Monitor for this side effect with prochlorperazine or metoclopramide; can be treated with diphenhydramine 8

Remember that the best approach to treating vomiting is addressing the underlying cause whenever possible, with antiemetics serving as symptomatic treatment.