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 medications, and if necessary, progressing to prescription antiemetics such as ondansetron (Zofran) 4-8 mg every 8 hours or promethazine (Phenergan) 12.5-25 mg every 4-6 hours as needed, as supported by the NCCN Guidelines for Antiemesis 1.
When managing nausea and vomiting, it's essential to consider the underlying cause and potential contributing factors, such as constipation, CNS pathology, or other medications 1. In the case of Famvir-induced nausea and vomiting, the following steps can be taken:
- Eat small, frequent meals rather than large ones, and choose bland foods like crackers, toast, and clear broths
- Stay hydrated with small sips of water or clear fluids
- Over-the-counter options include dimenhydrinate (Dramamine) 50-100 mg every 4-6 hours or meclizine (Bonine) 25 mg every 24 hours
- If these measures don't provide relief, contact your healthcare provider for prescription antiemetics
It's crucial to continue Famvir treatment despite these side effects, as stopping prematurely may reduce its effectiveness against the shingles virus 1. If nausea and vomiting are severe or persistent, your doctor might adjust your Famvir dosage or consider alternative antiviral medications like valacyclovir (Valtrex) or acyclovir (Zovirax). Additionally, corticosteroids can be beneficial in reducing nausea and vomiting, particularly when used in combination with metoclopramide and ondansetron 1.
In cases where nausea persists, alternative agents such as scopolamine, dronabinol, or olanzapine may be considered, and opioids rotation should be evaluated if necessary 1.
From the Research
Treatment of Nausea and Vomiting Caused by Famvir
- The studies provided do not directly address the treatment of nausea and vomiting caused by Famvir during the treatment of shingles 2, 3, 4.
- However, it is known that Famvir (famciclovir) is used to treat herpes zoster (shingles) and can cause side effects such as nausea and vomiting 3, 4.
- The treatment of nausea and vomiting in general can be managed with antiemetic drugs, fluid and electrolyte replacement, and nonpharmacologic management options such as small, frequent meals and avoidance of trigger foods 5, 6.
- In the case of medication-induced nausea and vomiting, such as that caused by Famvir, treatment may involve changing the medication or using antiemetic drugs to manage symptoms 6.
- A careful history of related factors is essential to guide the initial evaluation and narrow the differential diagnosis of nausea and vomiting, including the use of medications such as Famvir 6.