What are the treatment options for adolescent nausea and vomiting?

From the Guidelines

For adolescent nausea, treatment should begin with non-medication approaches and may include ondansetron (4-8mg every 8 hours) as a prescription medication option, as recommended by the most recent evidence 1.

Non-Medication Approaches

• Small, frequent meals
• Avoiding strong odors
• Staying hydrated with clear fluids

Over-the-Counter Options

• Ginger (250-500mg capsules every 6-8 hours)
• Antihistamines like dimenhydrinate (Dramamine, 50-100mg every 4-6 hours) or meclizine (Bonine, 25-50mg every 24 hours)

Prescription Medications

• Ondansetron (Zofran, 4-8mg every 8 hours) 1
• Promethazine (Phenergan, 12.5-25mg every 4-6 hours)
• Metoclopramide (Reglan, 5-10mg before meals and at bedtime) It's essential to identify and address the underlying cause of nausea, which could range from viral gastroenteritis to anxiety, migraines, or medication side effects 1. If nausea is accompanied by severe abdominal pain, persistent vomiting, signs of dehydration, or lasts more than 24-48 hours, medical attention should be sought promptly. The most recent evidence from 2022 supports the use of ondansetron for nausea and vomiting in patients with gastroparesis 1.

From the FDA Drug Label

Ondansetron tablets are indicated for the prevention of nausea and vomiting associated with: highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. Table 2: Pediatric Recommended Dosage Regimen for Prevention of Nausea and Vomiting Indication Dosage Regimen Moderately Emetogenic Cancer Chemotherapy 12 to 17 years of age: 8 mg administered 30 minutes before the start of chemotherapy, with a subsequent 8 mg dose 8 hours after the first dose. Then administer 8 mg twice a day (every 12 hours) for 1 to 2 days after completion of chemotherapy The recommended dosage regimens for adult and pediatric patients are described in Table 1 and Table 2, respectively

The treatment for adolescent nausea is ondansetron.

• The dosage regimen for adolescents (12 to 17 years of age) with moderately emetogenic cancer chemotherapy is 8 mg administered 30 minutes before the start of chemotherapy, with a subsequent 8 mg dose 8 hours after the first dose, then 8 mg twice a day for 1 to 2 days after completion of chemotherapy 2. Note: The provided drug label does not explicitly address the treatment of adolescent nausea outside of the context of chemotherapy or radiotherapy. Therefore, this answer is limited to the specific context of chemotherapy-induced nausea and vomiting.

From the Research

Treatment Options for Adolescent Nausea

• The treatment of adolescent nausea can be challenging, and it is essential to understand the underlying causes of the symptom 3.
• Functional nausea, a type of chronic nausea not associated with any underlying disease, may be considered a functional gastrointestinal disorder 3.
• Treatment strategies for chronic, functional nausea in children may include addressing gastrointestinal motor and sensory disturbances, autonomic imbalance, altered central nervous system pathways, or a combination of these 3.

Antiemetic Drugs

• Antiemetic drugs, such as serotonin and neurokinin antagonists (e.g., ondansetron and aprepitant), can be effective in treating chemotherapy-induced nausea and vomiting 4.
• Metoclopramide and antihistamines are first-line options for nausea and vomiting in pregnancy 4.
• However, dopamine antagonists, such as metoclopramide, can cause extrapyramidal adverse effects, particularly in children 4.

Evaluation and Treatment of Chronic Nausea and Vomiting

• The initial diagnostic evaluation of chronic nausea and vomiting involves distinguishing gastrointestinal causes from non-gastrointestinal causes 5.
• Treatment should be based on a thoughtful discussion of benefits, side effects, and costs, as a validated treatment algorithm for chronic nausea and vomiting does not exist 5.
• Neuromodulator agents, such as tricyclic antidepressants, gabapentin, olanzapine, mirtazapine, and benzodiazepines, and cannabinoids may be useful in the treatment of chronic symptoms 6.

Comparison of Antiemetic Drugs

• A randomized controlled trial comparing ondansetron, metoclopramide, and placebo for adults with undifferentiated emergency department nausea and vomiting found similar reductions in nausea severity for all three groups 7.
• However, there was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups 7.