Treatment of Nausea and Vomiting

Treatment of Nausea and Vomiting

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Treatment of Nausea and Vomiting

, Treatment of Nausea and VomitingPrinciple of treatment of vomiting:

The basic principle of vomiting is to correct any abnormality (medical disorder or a surgically correctable cause) that may be causing vomiting. In severe cases of vomiting hospitalization may be required, especially when dehydration is severe and oral re-hydration is not possible or practicable. Due to vomiting patient may not be able to take (medications or food/fluid) orally. Once patient can take orally, nutrients can be introduced in liquid form. Foods given to a patient with vomiting should contain low fat, low protein and low fiber (indigestible residues) as they delay gastric emptying, which may worsen the condition.

For treatment of nausea and vomiting, generally three approaches can be used, either alone or in combination. They are:

Anti-emetic drugs:

  • 5-HT3 antagonists such as ondensetron, granisetron etc. used commonly for chemotherapy induced and radiation induced and postoperative vomiting.
  • Antihistamines such as dimenhydrinate, meclizine, promethazine etc. used commonly in motion sickness, inner ear diseases.
  • Anticholinergic, e.g. scopolamine, used for motion sickness.
  • Anti-dopaminergic such as prochlorperazine used for drug/toxin induced vomiting.
  • Tricyclic antidepressants e.g. amitriptyline, nortriptyline etc. used for idiopathic nausea, functional vomiting, cyclic vomiting syndrome.
  • NK1 antagonist (e.g. aprepitant), used in chemotherapy induced vomiting.

Prokinetic agents:

  • Antidopaminergic and 5-HT4 agonists e.g. metoclopramide, used in gastroparesis.
  • Peripheral antidopaminergic, domperidone used for gastroparesis.
  • 5-HT4 agonist, e.g. Tegaserod used for gastroparesis, intestinal pseudoobstruction.
  • Somatostatin analogue (octreotide) used for intestinal pseudoobstruction.

Drugs used for especial settings:

  • Glucocorticoids (methylprednisolone), for chemotherapy induced vomiting. To prevent chemotherapy induced vomiting addition of glucocorticoids along with 5-HT3 antagonists, optimal anti-emetic effect can be obtained.
  • Benzodiazepines such as lorazepam are useful in reducing anticipatory nausea and vomiting in chemotherapy.

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