What medications can cause nausea?

From the Guidelines

Medications that can cause nausea include opioids, antibiotics, antifungals, and chemotherapy drugs, among others, and managing these side effects is crucial to improve patient quality of life. According to the study published in the Journal of the National Comprehensive Cancer Network 1, many medications can cause nausea and vomiting, and it is essential to identify and treat the underlying cause. Some common culprits include:

• Opioid pain medications, such as morphine, oxycodone, and hydrocodone
• Antibiotics, particularly macrolides like azithromycin and erythromycin
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen
• Chemotherapy drugs
• Certain antidepressants, especially SSRIs like fluoxetine and sertraline
• Oral contraceptives
• Diabetes medications like metformin
• Digoxin for heart conditions
• Iron supplements

These medications can cause nausea by irritating the stomach lining, stimulating the chemoreceptor trigger zone in the brain, slowing gastric emptying, or altering neurotransmitter levels that affect the digestive system. The study published in Annals of Oncology 1 also highlights that other emetogenic medications, such as amifostine, can cause nausea and vomiting. To manage medication-induced nausea, it is recommended to take medications with food (unless contraindicated), stay hydrated, and avoid lying down immediately after taking pills. If nausea is severe or persistent, consulting a healthcare provider is essential, as they may be able to adjust the dosage, switch to an alternative medication, or prescribe an anti-nausea medication to manage this side effect.

From the FDA Drug Label

The following adverse reactions have been reported in clinical trials of patients treated with ondansetron, the active ingredient of ondansetron tablets. Symptoms associated with serotonin syndrome may include the following combination of signs and symptoms: ... nausea, vomiting, diarrhea The most common adverse reactions reported in greater than or equal to 4% of 300 adults receiving a single 24 mg dose of ondansetron tablets orally in 2 trials for the prevention of nausea and vomiting associated with highly emetogenic chemotherapy (cisplatin greater than or equal to 50 mg/m 2) were: headache (11%) and diarrhea (4%) The antiemetic properties of metoclopramide appear to be a result of its antagonism of central and peripheral dopamine receptors Dopamine produces nausea and vomiting by stimulation of the medullary chemoreceptor trigger zone (CTZ), and metoclopramide blocks stimulation of the CTZ by agents like l‑dopa or apomorphine which are known to increase dopamine levels or to possess dopamine-like effects.

Medications that can cause nausea include:

• Ondansetron: can cause nausea as a symptom of serotonin syndrome, and also as an adverse reaction in clinical trials
• Metoclopramide: can cause nausea as a result of its effects on dopamine receptors, although it is also used as an antiemetic to prevent nausea and vomiting 2 3

From the Research

Medications that can Cause Nausea

• Various medications can cause nausea as an adverse effect, including:
  • Serotonin antagonists, such as ondansetron 4
  • Dopamine antagonists, such as metoclopramide 4
  • Antihistamines 4
  • 5-HT(3)-receptor antagonists, such as dolasetron and ondansetron 5
  • Benzodiazepines 4
  • Corticosteroids 4
• These medications can be used to treat nausea and vomiting, but they can also cause nausea as a side effect in some cases.

Specific Medications and their Side Effects

• Metoclopramide can cause extrapyramidal adverse effects, particularly in children 4
• Ondansetron can cause central nervous system side effects, such as headache and dizziness 5
• Dolasetron can cause cardiovascular effects, such as prolongation of cardiac conduction intervals 5
• Promethazine can cause sedation and dry mouth 6
• Droperidol can cause sedation and hypotension 6

Importance of Individualized Treatment

• The choice of medication for nausea and vomiting should be individualized based on the patient's specific needs and medical history 4, 5, 6
• Patients should be evaluated on an individual basis to determine the best course of treatment 5
• The use of antiemetic medications should be guided by the underlying cause of nausea and vomiting, as well as the patient's overall health status 4, 7, 8