What is the best way to stop vomiting due to food poisoning while taking escitalopram (selective serotonin reuptake inhibitor, SSRI)?

Best Treatment for Vomiting from Food Poisoning While Taking Escitalopram

For patients taking escitalopram who are experiencing vomiting due to food poisoning, ondansetron (4-8 mg orally or intravenously every 8 hours) is the most effective first-line treatment option to control vomiting. 1, 2

First-Line Treatment Options

• Dopamine receptor antagonists are recommended as first-line treatments for vomiting due to food poisoning:

  • Metoclopramide 10-20 mg PO/IV every 4-6 hours 1, 2
  • Prochlorperazine 10 mg PO/IV every 6 hours 1

• 5-HT3 receptor antagonists are particularly effective and should be considered first-line when taking escitalopram:

  • Ondansetron 4-8 mg PO/IV every 8-12 hours (preferred option) 1, 2
  • Granisetron 1-2 mg PO daily 1

Special Considerations with Escitalopram

• When taking escitalopram (an SSRI), it's important to avoid medications that might increase serotonin levels further, as this could potentially lead to serotonin syndrome 3
• Ondansetron is particularly safe to use with escitalopram as it doesn't significantly interact with SSRIs 2, 4
• Avoid using metoclopramide at high doses with escitalopram due to potential for increased risk of serotonin syndrome 1, 3

Administration Tips

• Schedule antiemetics around-the-clock rather than as-needed for persistent vomiting 1, 2
• Oral rehydration is crucial during food poisoning - small, frequent sips of clear fluids once vomiting is controlled 5
• Consider adding an H2 blocker (such as famotidine) or proton pump inhibitor if there's associated gastric discomfort 1

For Refractory Vomiting

If vomiting persists despite first-line treatment:

• Add dexamethasone 4-8 mg PO/IV once daily 1, 2
• Consider olanzapine 2.5-5 mg PO/sublingual every 6-8 hours (particularly effective for refractory nausea/vomiting) 1
• Lorazepam 0.5-2 mg PO/SL/IV every 6 hours can be added for anxiety-related nausea 1

Monitoring and Precautions

• Monitor for extrapyramidal symptoms if using metoclopramide or prochlorperazine 2
• Be aware of potential sedation with antihistamines and olanzapine, especially when combined with escitalopram 2
• 5-HT3 antagonists can cause constipation, which may worsen overall comfort 2
• If vomiting persists for more than 24-48 hours or is accompanied by severe abdominal pain, high fever, or bloody diarrhea, seek immediate medical attention 5

Common Pitfalls to Avoid

• Don't use high doses of metoclopramide in combination with escitalopram due to potential serotonergic effects 1, 3
• Avoid phenothiazines at high doses with escitalopram due to potential QT prolongation 3
• Don't neglect hydration while focusing on controlling vomiting 5
• Remember that food poisoning is usually self-limiting, and antiemetic treatment should be short-term 5