What are the recommended at-home treatments for nausea and vomiting?

At-Home Treatments for Nausea and Vomiting

For at-home management of nausea and vomiting, lifestyle modifications should be implemented first, followed by a stepwise approach to medication use based on symptom severity, with dopamine antagonists as first-line pharmacologic therapy.

Non-Pharmacological Approaches

• Eat small, frequent meals rather than large meals to avoid overwhelming the digestive system 1
• Choose healthful foods and control the amount of food consumed 1
• Consume food at room temperature, as hot foods may worsen nausea due to strong aromas 1
• Consider using ginger, which may help alleviate nausea symptoms, though evidence remains insufficient for a formal recommendation 1
• Maintain adequate hydration with small, frequent sips of clear fluids 2
• Identify and avoid personal trigger foods that worsen symptoms 2

First-Line Pharmacologic Treatment

• Dopamine receptor antagonists are recommended as first-line therapy for persistent nausea and vomiting 2:

  • Prochlorperazine 5-10 mg orally every 6-8 hours as needed
  • Metoclopramide 10 mg orally three times daily before meals
  • Haloperidol 0.5-1 mg orally every 8 hours as needed

• Monitor for extrapyramidal side effects with dopamine receptor antagonists, particularly with prolonged use 2

Second-Line Pharmacologic Treatment

If symptoms persist despite first-line therapy, add one of the following:

• 5-HT3 receptor antagonists such as ondansetron 4-8 mg orally every 8 hours 2, 3
• Antihistamines such as meclizine 25 mg orally every 4-6 hours 2
• Anticholinergic agents such as scopolamine transdermal patch 1.5 mg applied behind the ear every 72 hours 2

For Anxiety-Related Nausea

• Consider adding benzodiazepines such as lorazepam 0.5-2 mg orally, intravenously, or sublingually every 4-6 hours 1, 2
• Be cautious with long-term benzodiazepine use due to risk of dependence 2

For Gastroesophageal Reflux Contributing to Nausea

• Consider H2 blockers or proton pump inhibitors to prevent dyspepsia, which can mimic nausea 1, 2

Special Considerations

For Chemotherapy-Induced Nausea and Vomiting

• Follow specific antiemetic guidelines based on the emetogenic potential of the chemotherapy regimen 1
• For highly emetogenic chemotherapy, use a combination of NK1 receptor antagonist, 5-HT3 receptor antagonist, and dexamethasone 1

For Refractory Symptoms

• Consider adding corticosteroids such as dexamethasone 4-8 mg orally or intravenously 2
• Olanzapine 2.5-5 mg orally at bedtime may be effective for persistent symptoms 1, 2

Important Pitfalls to Avoid

• Avoid antiemetics in patients with suspected mechanical bowel obstruction 2
• When using combination therapy, target different mechanisms of action for synergistic effect rather than replacing one antiemetic with another 2
• Monitor for medication side effects, particularly sedation with antihistamines and extrapyramidal symptoms with dopamine antagonists 2, 4
• Recognize that chronic nausea (lasting >4 weeks) may require different management strategies than acute nausea 5, 6
• Be aware that ondansetron is contraindicated in patients receiving apomorphine due to risk of profound hypotension 3

When to Seek Medical Attention

• Persistent vomiting lasting more than 24 hours 7
• Signs of dehydration (decreased urination, dry mouth, dizziness) 7
• Blood in vomit or stool 6
• Severe abdominal pain 6
• Fever above 101°F (38.3°C) 7