What is the intravenous (IV) treatment for nausea in the in-patient setting?

From the Guidelines

Intravenous treatment for nausea in the inpatient setting should start with ondansetron 8-mg IV bolus followed by 1 mg/h of continuous infusion, as recommended by the guidelines developed at Mayo Clinic Rochester 1. This approach is based on the guidelines that attempted to identify the most appropriate therapy as determined by the literature, taking into account the grades of emetogenicity and the development of antiemetic treatment regimens for each grade.

• The use of ondansetron as a first-line treatment is supported by its effectiveness in blocking serotonin receptors in the chemoreceptor trigger zone.
• The specific dosing regimen of an 8-mg IV bolus followed by 1 mg/h of continuous infusion is outlined in the guidelines as an option for inpatients.
• It is essential to monitor patients for potential side effects, including QT prolongation with ondansetron, and to adjust the treatment plan accordingly.
• Identifying and treating the underlying cause of nausea concurrently is crucial for the most effective approach, addressing both symptoms and their source.
• Other treatment options, such as metoclopramide or promethazine, may be considered for patients who do not respond adequately to ondansetron, but the guidelines specifically recommend ondansetron as a starting point 1.

From the FDA Drug Label

In a double-blind, placebo-controlled trial conducted in 468 males undergoing outpatient procedures, a single 4-mg intravenous ondansetron dose prevented postoperative vomiting over a 24-hour period in 79% of males receiving drug compared with 63% of males receiving placebo (P <0. 001). Ondansetron Injection (4 mg) intravenous given over 2 to 5 minutes was significantly more effective than placebo. Patients who experienced an episode of postoperative nausea and/or vomiting were given Ondansetron Injection (4 mg) intravenously over 2 to 5 minutes, and this was significantly more effective than placebo.

The intravenous (IV) treatment for nausea in the in-patient setting is ondansetron 4 mg IV. This dose has been shown to be effective in preventing postoperative nausea and vomiting in adult patients 2.

• Key points:
  • Ondansetron 4 mg IV is effective in preventing postoperative nausea and vomiting.
  • This dose is given over 2 to 5 minutes.
  • It is significantly more effective than placebo in adult patients.

From the Research

Intravenous (IV) Treatment for Nausea

• The IV treatment for nausea in the in-patient setting can include various medications, such as:
  • Dolasetron, a 5-HT3 antagonist, which has been shown to be effective in preventing acute chemotherapy-induced nausea and vomiting (CINV) 3
  • Ondansetron, also a 5-HT3 antagonist, which has been found to be effective in preventing cisplatin-induced emesis and is often used in combination with dexamethasone 4, 5
  • Aprepitant, a neurokinin-1 receptor antagonist, which has been used to treat refractory nausea caused by gastroparesis, although its use in this setting is not FDA-approved 6
• The choice of medication may depend on various factors, including the underlying cause of nausea, patient preferences, and adverse effect profiles
• Studies have compared the efficacy of different antiemetic medications, including metoclopramide, prochlorperazine, promethazine, and droperidol, although the evidence is limited and the quality of the evidence is often low 7

Dosage and Administration

• The dosage and administration of IV antiemetic medications can vary depending on the specific medication and the patient's condition
• For example, dolasetron can be administered at a dose of 1.8 mg/kg IV, while ondansetron can be administered at a dose of 0.15 mg/kg IV before and after cisplatin chemotherapy 3, 4
• Aprepitant can be administered at a dose of 40 mg daily, although its use in the in-patient setting may be limited by cost and availability 6

Efficacy and Safety

• The efficacy and safety of IV antiemetic medications can vary depending on the specific medication and the patient's condition
• Studies have reported that ondansetron and dolasetron are generally well-tolerated and effective in preventing nausea and vomiting, although adverse events such as headache, dizziness, and diarrhea can occur 3, 4, 5
• Aprepitant has also been found to be effective in treating refractory nausea, although its safety profile is not as well-established in this setting 6