What medication is used to treat persistent vomiting (emesis)?

From the Guidelines

For persistent vomiting, I recommend starting with antiemetic medications such as ondansetron (Zofran) 4-8mg orally every 8 hours as needed, based on the most recent and highest quality study available 1.

Medication Options

• Ondansetron (Zofran) 4-8mg orally every 8 hours as needed
• Metoclopramide (Reglan) 10mg orally or intravenously every 6 hours, especially for gastroparesis-related vomiting
• Domperidone, a dopamine D2-receptor antagonist, with a recommended starting dose of 10 mg 3 times a day
• 5-Hydroxytryptamine3 (5-HT3) receptor antagonists, such as granisetron, available in liquid, tablets, and transdermal patch forms
• Neurokinin (NK-1) receptor antagonists, such as aprepitant, which have shown improvement in nausea and vomiting in patients with refractory gastroparesis symptoms

Important Considerations

• Staying hydrated by taking small sips of clear fluids or sucking on ice chips
• Using electrolyte replacement solutions like Pedialyte to prevent dehydration
• Seeking immediate medical attention if vomiting persists beyond 24-48 hours, is accompanied by severe abdominal pain, contains blood, or occurs with high fever, as these could indicate a serious underlying condition requiring different treatment
• The choice of medication depends on the underlying cause of vomiting and individual patient factors, as noted in the study 1

Additional Treatment Options

• Phenothiazine antipsychotics, such as prochlorperazine, which reduce nausea and vomiting by inhibiting dopamine receptors in the brain
• Corticosteroids, such as dexamethasone, which can be effective in reducing opioid-induced nausea and vomiting, as mentioned in the study 1
• Cannabinoids, such as dronabinol, which have been FDA-approved for chemotherapy-induced nausea and vomiting, as noted in the study 1

From the FDA Drug Label

Ondansetron was significantly more effective than placebo in preventing nausea and vomiting. A single 0. 1-mg/kg intravenous dose of ondansetron administered within 5 minutes following induction of anesthesia was statistically significantly more effective than placebo in preventing vomiting. 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. Ondansetron was significantly more effective than placebo in preventing further episodes of nausea and vomiting.

Ondansetron is used to treat persistent vomiting (emesis) 2.

• It is administered intravenously, with dosages varying by patient weight and age.
• It has been shown to be effective in preventing nausea and vomiting in both adult and pediatric patients.

From the Research

Medications for Treating Persistent Vomiting

• Ondansetron is a commonly used antiemetic agent for the treatment of nausea and vomiting in adults and children 3, 4, 5, 6.
• It is effective in relieving symptoms of vomiting and is not associated with sedation or akathisia 3.
• The recommended dose of ondansetron for children is 0.2 mg/kg orally or 0.15 mg/kg parenterally, with a maximum dose of 4 mg 4.
• Other antiemetic agents, such as promethazine, prochlorperazine, metoclopramide, and domperidone, may also be used to treat vomiting, but they have different side effect profiles and may not be as effective as ondansetron 3, 7, 6.
• Domperidone has been compared to ondansetron in several studies, with mixed results, but ondansetron appears to be more efficacious in cessation of vomiting associated with acute gastroenteritis 5, 6.

Specific Uses of Ondansetron

• Ondansetron is indicated for use in children who are unable to take oral fluids due to persistent vomiting, post-operative vomiting, chemotherapy-induced vomiting, cyclic vomiting syndrome, and acute mountain sickness 4.
• It is also used in adults for the treatment of nausea and vomiting in the emergency department, particularly when sedation is not desirable 3.

Comparison of Antiemetic Agents

• A study comparing ondansetron and domperidone for the symptomatic treatment of vomiting in children with acute gastroenteritis found that ondansetron was more effective in reducing the number of vomiting episodes 6.
• Another study found that ondansetron was as effective as promethazine in relieving symptoms of nausea and vomiting, but had a more favorable side effect profile 3.