From the Research
For a patient with a history of hypertension and coronary artery disease with stent placement who needs nausea medication, metoclopramide (Reglan) 10mg orally or IV every 6 hours as needed is generally a safe first-line option. This recommendation is based on the need to balance effective nausea relief with the potential risks associated with other antiemetic medications in patients with cardiovascular conditions. Ondansetron (Zofran) 4-8mg orally or IV every 8 hours can also be used but with caution due to its potential to prolong the QT interval, which requires monitoring in cardiac patients 1.
Key considerations in choosing an antiemetic for these patients include:
- Avoiding medications that may lower blood pressure and worsen hypertension control, such as prochlorperazine (Compazine) and promethazine (Phenergan) 2, 3.
- Avoiding domperidone due to its potential cardiac effects 4, 5.
- Starting with the lowest effective dose and monitoring blood pressure and cardiac symptoms when using any antiemetic.
- Consulting with the patient's cardiologist for persistent nausea to ensure the chosen antiemetic won't interact with their cardiac medications, particularly antiplatelet therapy that's likely prescribed for their stent 1.
The management of hypertension in patients with coronary artery disease involves the use of beta blockers, ACE inhibitors, or angiotensin receptor blockers (ARBs), with the goal of achieving a blood pressure of <140/90 mm Hg in patients aged ≤ 80 years and a systolic blood pressure < 150 mm Hg in those ≥ 80 years 2, 3. However, the choice of antiemetic should prioritize minimizing risks associated with the patient's cardiovascular conditions while providing effective nausea relief.