What are the treatment options for nausea?

From the Guidelines

For nausea treatment, the most effective approach is to start with vitamin B6 and doxylamine, followed by ondansetron, metoclopramide, or promethazine for more severe cases, as recommended by the most recent guidelines 1.

Nausea Treatment Options

The treatment of nausea involves a stepwise approach, considering the severity of symptoms and the underlying cause.

• For mild nausea, vitamin B6 and doxylamine can be used as first-line treatment, as they are effective in controlling symptoms and have a favorable safety profile 1.
• For more severe nausea, prescription medications like ondansetron (4-8mg every 8 hours), metoclopramide (10mg before meals), or promethazine (12.5-25mg every 4-6 hours) may be necessary, as they have been shown to be effective in reducing nausea and vomiting in various clinical settings 1.

Additional Considerations

• It is essential to stay hydrated with small sips of clear fluids, eat bland foods like crackers or toast, and avoid strong odors, spicy foods, and dairy to help manage nausea.
• Resting in a cool, well-ventilated area and trying deep breathing exercises can also help alleviate symptoms.
• If nausea persists beyond 24-48 hours, is accompanied by severe abdominal pain, high fever, or signs of dehydration, seeking medical attention immediately is crucial to prevent complications and ensure proper management.

From the FDA Drug Label

In 2 randomized, double-blind, monotherapy trials, a single 24 mg oral dose of ondansetron tablets was superior to a relevant historical placebo control in the prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2 A total of 66% of patients in the ondansetron 24 mg once-a-day group, 55% in the ondansetron 8 mg twice-a-day group, and 55% in the ondansetron 32 mg once-a-day group, completed the 24-hour trial period with 0 emetic episodes and no rescue antiemetic medications, the primary endpoint of efficacy In the same trial, 56% of patients receiving a single 24 mg oral dose of ondansetron experienced no nausea during the 24-hour trial period

Nausea treatment: Ondansetron is effective in preventing nausea and vomiting associated with highly emetogenic cancer chemotherapy.

• A single 24 mg oral dose of ondansetron can prevent nausea in 56% of patients.
• The recommended dosage for preventing nausea and vomiting associated with highly emetogenic chemotherapy is a single 24 mg oral dose of ondansetron 2.

From the Research

Nausea Treatment Options

• The main antiemetic classes include antagonists of the serotonin, dopamine, histamine, muscarinic and neurokinin systems, corticosteroids and benzodiazepines 3
• Serotonin and neurokinin antagonists, such as ondansetron and aprepitant, are highly effective in treating chemotherapy-induced nausea and vomiting 3
• Metoclopramide and antihistamines are first-line options for nausea and vomiting in pregnancy 3

Treatment for Nausea and Vomiting in Pregnancy

• Ginger, vitamin B6, antihistamines, metoclopramide, pyridoxine-doxylamine, and ondansetron were associated with improved symptoms compared with placebo 4
• Pyridoxine-doxylamine combination taken preemptively reduced risk of recurrence of moderate-severe symptoms compared with treatment once symptoms begin 4
• Ondansetron was associated with lower nausea scores on day 4 than metoclopramide 4

Evaluation and Treatment of Nausea and Vomiting in Adults

• Acute nausea and vomiting are typically treated symptomatically and without an extensive evaluation 5
• Chronic nausea and vomiting have a broad differential diagnosis and require a careful history of related factors to guide the initial evaluation and narrow the differential diagnosis 5
• Nonpharmacologic management options include fluid and electrolyte replacement, small, frequent meals, and avoidance of trigger foods 5
• Antiemetic drugs effectively reduce symptoms of acute nausea and vomiting, but chronic symptoms are often more challenging to treat 5

Antiemetic Therapy in the Emergency Department

• Ondansetron is as effective as promethazine and is not associated with sedation or akathisia, making it a suitable first-line agent for relief of nausea or vomiting for most patient populations in the ED 6
• Droperidol is more effective than prochlorperazine or metoclopramide, but its use is limited due to the potential for QT prolongation 6
• Promethazine is more sedating than other comparative agents and has the potential for vascular damage upon intravenous administration 6