Nausea and Vomiting (OTC Treatment)


  • Nausea: uncomfortable sensation in the  stomach that can result in vomiting
  • Vomiting : expulsion of stomach contents in a forceful manner
  • Most common reason for N/V: motion sickness, food, stress, migraine, overindulgence, pregnancy
  • Be concerned if vomiting lasts over 24 h, blood or bile in vomit, rapid breathing/pulse
  • Simple nausea with vomiting: usually 1-2 episodes of vomiting
    • Simple nausea doesn’t usually require oral rehydration treatment
  • Things used for nausea, vomiting, motion sickness
    • Antihistamines (meclizine, cyclizine, diphenhydramine, doxylamine, dimenhydrinate)
      • Cyclizine:  avg kid dose = 25mg;  avg adult dose = 50mg;  max daily adult dose = 200mg/day
      • Dull the inner ear senses & block messages to the brain that control nausea & vomiting
      • Anticholinergic side effects (can’t pee, can’t spit, can’t see, can’t shit)
      • Ppl at risk: glaucoma, high BP, prego/breast feeding–vitamin B6 is safer than antihistamines in prego women, thyroid cancer)
    • Sea-Band (FDA approved):  applies pressure at the P6 (Nei Kuan) pressure point
      • Suitable for kids & adults  (no consequences of use or at risk populations)
    • Relief Band (FDA cleared): uses mild electronic pulse to stimulate P6 pressure point
      • Prevents & reverses symptoms of motion sickness
      • Shock/water resistant
      • Has a latex band (be careful of patients w/ latex allergy)
    • Emetrol
  • Treatments for morning sickness (N/V in prego)
    • Antihistamines (not  FDA approved) with the consultation of a doctor
    • Vitamin B6:  10-25mg TID, use intermittently in early pregnancy to reduce tolerance & reduce N/V
      • Least incidence of adverse effects
    • Ginger: listed as possibly effective & likely safe by the NMCD
      • Antiemetic action is mostly localized in the GI but has some central action
        • Seems to act primarily on the 5HT receptor in the ileum (like Zofran)
      • Usually well tolerated but in doses > 5 grams there can be an increase risk of side effects
      • Dose: 250mg qid
    • Phosphorylated carbohydrate solutions (emetrol, coca-cola): act locally in GI to decrease smooth muscle contraction & delay gastric emptying (dose dependent)
      • May upset stomach & in large doses may cause diarrhea, stomach or abdominal pain
      • At risk populations: diabetics, fructose-intolerant ppl
    • Semi-pharmacologic ingredients:
      • Preggie pops–convenient, relief via a combo of “essential oils, aromatherapy, a unique delivery system”
      • Very few side effects & the only at risk populations are ppl sensitive to the ingredients (fruit juices)
  • Treatments for N/V due to overindulgence of food/drink:  antacids (may help), H2RA, PPIs (doesn’t provide immediate relief), pepto-bismol (salicylate)
  • Hangover
    • May weaken the immune system, cause urinary frequency, dehydration
    • Caffeine increases dehydration
    • Alcohol irritates the stomach lining
    • Hangover depends upon the amount of alcohol consumed (rather than the type of alcohol drank)
    • Best therapy for hangovers:  hydration, time, bland food in small amounts, carbs
    • GTF chromium  (used as hangover cure)
      • Contains aspirin, chromium (which is supposed to turn alcohol into sugar) & calcium carb
        • Chromium is involved in the metabolism & storage of carbs, fat & protein
          • Chromium enhances the action of insulin (also beta-blockers, corticosteroids, NSAIDs, IBU, ASA)
          • Drugs that decrease chromium levels:  antacids, H2 blockers (cimetidine), corticosteroids, PPIs
          • People who need chromium supplementation:  elderly, maybe ppl with type II diabetes
  • If a patient is nauseated & has severe upper right quadrant abdominal pain after eating a fatty meal refer them to a doctor (upper right quadrant pain is bad)

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