From the Guidelines
For inpatient management of nausea and vomiting, ondansetron (16-24 mg oral, once daily) is a recommended option, as it is a serotonin antagonist with a well-established efficacy profile 1. When considering the treatment of nausea and vomiting in inpatients, several factors must be taken into account, including the underlying cause, patient-specific factors, and potential side effects.
- The choice of antiemetic medication depends on these factors, with options including:
- Serotonin antagonists (e.g., ondansetron, granisetron, tropisetron, dolasetron) given once daily
- Dopamine antagonists (e.g., metoclopramide, prochlorperazine, domperidone, metopimazine) given 3-4 times daily
- Corticosteroids (e.g., dexamethasone, prednisolone, methylprednisolone) given once daily
- Neurokinin antagonists (e.g., aprepitant) given once daily
- According to the evidence, ondansetron is a suitable option, with an oral dose of 16-24 mg once daily 1.
- It is essential to monitor hydration status closely and administer IV fluids if the patient shows signs of dehydration.
- Treatment should continue until nausea and vomiting resolve, and the patient can tolerate oral intake, typically reassessing after 24-48 hours of therapy.
- The selection of antiemetic medication should be guided by the most recent and highest-quality evidence, with consideration of the patient's individual needs and potential side effects.
From the FDA Drug Label
- superior to placebo (historical control) in all efficacy parameters: complete response (52%), no vomiting (56%) and no nausea (45%). The efficacy of Granisetron HCl Tablets 2 mg qd was comparable to Granisetron HCl Tablets 1 mg bid and statistically superior to placebo. Granisetron HCl provided significantly greater protection from nausea and vomiting than placebo.
The inpatient medication for nausea and vomiting is Granisetron (IV), as it has been shown to be effective in preventing nausea and vomiting in patients undergoing chemotherapy and radiation therapy 2.
- Key benefits of Granisetron include:
- Complete response (52%)
- No vomiting (56%)
- No nausea (45%)
- Dosage: Granisetron HCl Tablets 2 mg qd or 1 mg bid.
From the Research
Inpatient Medications for Nausea and Vomiting
The following medications are used to treat nausea and vomiting in inpatient settings:
- Droperidol: commonly used in the past, but its use is limited due to the potential for QT prolongation 3
- Promethazine: more sedating than other comparative agents, and has the potential for vascular damage upon intravenous administration 3
- Prochlorperazine: must be monitored for akathisia that can develop at any time over 48 h post administration 3
- Metoclopramide: must be monitored for akathisia that can develop at any time over 48 h post administration 3
- Ondansetron: as effective as promethazine, and is not associated with sedation or akathisia 3, 4, 5, 6
- Aprepitant: reduces vomiting, with high-certainty evidence 5
- Ramosetron: reduces vomiting, with high-certainty evidence 5
- Granisetron: reduces vomiting, with high-certainty evidence 5
- Dexamethasone: reduces vomiting, with high-certainty evidence 5
- Fosaprepitant: probably reduces vomiting, with moderate-certainty evidence 5
Comparison of Medications
- Ondansetron and prochlorperazine appear to be equally effective at treating vomiting in the emergency department 4
- Ondansetron is as effective as promethazine, and is not associated with sedation or akathisia 3
- Combinations of drugs were generally more effective than single drugs in preventing vomiting 5
- NK₁ receptor antagonists were the most effective drug class and had comparable efficacy to most of the drug combinations 5