Gravol (Dimenhydrinate) for Viral Gastroenteritis in Children
Gravol (dimenhydrinate) is NOT recommended as routine treatment for viral gastroenteritis in children, and oral rehydration therapy remains the cornerstone of management. 1, 2
Primary Treatment Approach
Oral rehydration solution (ORS) is the first-line treatment for mild-to-moderate dehydration in children with viral gastroenteritis. 2 The CDC explicitly states that nonspecific antidiarrheal and antiemetic agents (including dimenhydrinate) do not demonstrate effectiveness in reducing diarrhea volume or duration, and their use shifts therapeutic focus away from appropriate fluid and electrolyte therapy. 1
- Reduced-osmolarity ORS should be administered using small, frequent volumes (5-10 mL every 1-2 minutes), which successfully rehydrates >90% of children with vomiting and diarrhea without antiemetic medication. 3
- Breastfeeding should be continued throughout the illness, and age-appropriate diet should be resumed immediately after rehydration. 2
- For moderate dehydration, administer ORS at 100 mL/kg over 2-4 hours. 3
Evidence on Dimenhydrinate Efficacy
While one randomized controlled trial showed dimenhydrinate reduced vomiting frequency (69.6% vomiting-free vs 47.4% placebo), the overall clinical benefit was low because it did not improve oral rehydration success or clinical outcomes. 4 A Cochrane review found dimenhydrinate suppository reduced mean time to cessation of vomiting by only 0.34 days. 5
Critical Safety Concerns
Dimenhydrinate is contraindicated in neonates and contains benzyl alcohol, which has been associated with fatal "Gasping Syndrome" in premature infants and low birth weight infants. 6 The CDC warns that antiemetic agents can cause significant side effects including drowsiness, nausea from atropine effects, and binding of nutrients. 1
When Antiemetics May Be Considered
If a child is >4 years old AND vomiting significantly interferes with oral rehydration attempts, ondansetron (NOT dimenhydrinate) is the preferred antiemetic. 2, 7, 3 The IDSA specifically recommends ondansetron may be given only to children >4 years of age to facilitate oral rehydration, but it is NOT recommended for children <4 years. 2
- Ondansetron dosing: 0.15 mg/kg (maximum 16 mg per dose) orally, intramuscularly, or intravenously. 7, 3
- Ondansetron should only be used after ensuring adequate hydration or alongside rehydration efforts—it is NOT a substitute for fluid therapy. 7, 3
- Screen for cardiac history before ondansetron use due to QT prolongation risk. 7, 3
Common Pitfalls to Avoid
- Do NOT use dimenhydrinate or any antiemetic as first-line treatment—focus on proper ORS administration technique instead. 1, 2
- Do NOT delay rehydration while administering antiemetics. 3
- Do NOT use antiemetics in children <4 years as routine practice. 2
- Do NOT use antiemetics in cases of bloody diarrhea or suspected bacterial gastroenteritis. 3
- Do NOT rely on sports drinks or apple juice as primary rehydration solutions. 3
Indications for Emergency Care
Seek immediate medical attention if the child develops severe dehydration signs: altered mental status, severe lethargy, poor perfusion, shock, or inability to tolerate any oral fluids. 2 Approximately 15% of children with severe gastroenteritis develop hypovolemic shock requiring aggressive IV fluid resuscitation. 2