From the Guidelines
To manage nausea and vomiting caused by Famvir (famciclovir) during shingles treatment, I recommend starting with simple dietary modifications and over-the-counter options before considering prescription medications.
Initial Management
- Eat small, frequent meals rather than large ones, and choose bland foods like crackers, toast, or rice.
- Stay hydrated with clear fluids such as water, ginger ale, or clear broth.
- Over-the-counter options include ginger supplements (250mg four times daily), vitamin B6 (25mg three times daily), or antihistamines like dimenhydrinate (Dramamine, 50-100mg every 4-6 hours as needed) 1.
Prescription Antiemetics
If these measures don't provide relief, contact your healthcare provider about prescription antiemetics such as:
- Ondansetron (Zofran, 4-8mg every 8 hours)
- Promethazine (Phenergan, 12.5-25mg every 4-6 hours)
- Metoclopramide (Reglan, 10mg before meals) 1. It's essential to continue Famvir as prescribed to effectively treat shingles, as interrupting treatment may compromise its effectiveness. These side effects typically resolve as your body adjusts to the medication or after completing the treatment course, which usually lasts 7 days.
Persistent Nausea and Vomiting
For persistent nausea and vomiting, consider adding therapies that target different mechanisms of action, resulting in a synergistic effect, such as serotonin receptor antagonists like granisetron or ondansetron, which have a lower rate of CNS effects 1. Alternative agents like scopolamine, dronabinol, or olanzapine may also be considered for management of nausea. Corticosteroids can also be beneficial for reducing nausea and vomiting, particularly in combination with metoclopramide and ondansetron 1.
From the FDA Drug Label
The most common adverse events reported in at least 1 indication by greater than 10% of adult patients treated with famciclovir are headache and nausea. Nausea 12.5 Vomiting 4.8
Treatment of nausea and vomiting caused by famciclovir during treatment of shingles is not explicitly stated in the provided drug label. However, it is mentioned that nausea and vomiting are common adverse events associated with famciclovir treatment.
- No specific guidance is provided for managing these symptoms.
- The label does not offer any recommendations for the treatment of nausea and vomiting caused by famciclovir 2.
From the Research
Treatment of Nausea and Vomiting
- Nausea and vomiting are common symptoms that can be caused by various factors, including medications such as Famvir (famciclovir) used in the treatment of shingles 3, 4.
- The treatment of nausea and vomiting depends on the underlying cause, and in the case of medication-induced symptoms, it may involve changing the medication or adding an antiemetic drug 5.
- For chronic nausea and vomiting, which can be caused by Famvir, treatment should be based on a thoughtful discussion of benefits, side effects, and costs, and may involve non-pharmacologic management options such as fluid and electrolyte replacement, small frequent meals, and avoidance of trigger foods 6, 5.
- Pharmacologic therapy for nausea and vomiting may include antiemetic drugs, serotonin antagonists, or dopamine antagonists, and should be used for the shortest time necessary to control symptoms 5, 7.
- In some cases, neuromodulator agents such as tricyclic antidepressants, gabapentin, olanzapine, mirtazapine, and benzodiazepines, and cannabinoids may be useful in the treatment of chronic nausea and vomiting 7.
Management of Medication-Induced Nausea and Vomiting
- When nausea and vomiting are caused by a medication such as Famvir, the first step is to try to manage the symptoms using non-pharmacologic methods or antiemetic drugs 5.
- If the symptoms persist, it may be necessary to change the medication or adjust the dosage 3, 4.
- It is essential to weigh the benefits and risks of continuing the medication against the potential benefits of changing to a different treatment 6, 5.
Importance of Proper Evaluation and Treatment
- Proper evaluation and treatment of nausea and vomiting are crucial to prevent complications, improve quality of life, and reduce the economic impact of these symptoms 6, 5.
- A careful history and physical examination are essential to guide the initial evaluation and narrow the differential diagnosis 5.
- Treatment should be individualized based on the underlying cause, severity of symptoms, and patient preferences 7.