Unpleasant sensation associated with the urge to vomit.
- Drugs and toxins
- Post-operative nausea and vomiting
- Vestibular disorders
- Gastric outflow obstruction
- Bowel obstruction, especially more proximal
- Raised intra-cranial pressure
This is often less than optimal as much prescribing is by analogy and outside the strict license of the respective products. Prescribers are often ignorant of relevant issues resulting in adverse effects. Any guideline older than 2014 is likely to be out of date as many products have been subject to regulatory action in the last few years !
- Prescribe only when the cause of vomiting is known as a rule as they may delay diagnosis.
- Unnecessary and sometimes harmful when the cause can be treated, such as in diabetic ketoacidosis, or in digoxin or other drug overdose where their drug-drug interactions could cause malignant arrhythmias or other side effects.
- It is very important to anticipate nausea and vomiting with certain therapies. Where this is likely it should be recognised that there are three different situations:
- Acute: This usually happens during or within several hours of systemic medication administration
- Delayed: Can happen and continue for several days after the treatment has been administered
- Anticipatory: If nausea and vomiting is not well controlled in the previous two phases, patients may experience a conditioned response of nausea and vomiting prior to receiving treatment
- Chose drug according to the aetiology of vomiting.
- Other medications patient is on
- Renal impairment
- Hepatic failure
- Effective against nausea and vomiting resulting from many underlying conditions.
- Act centrally by blocking the chemoreceptor trigger zone.
- With the exception of domperidone not recommended in Parkinsonism
- Contraindicated in mechanical bowel obstruction, perforation and haemorrhage
- Acute dystonia problems
- QT problems
- Phenothiazines such as prochlorperazine, haloperidol, levomepromazine and chlorpromazine
- Butyrophenones such as droperidol
- Second line
- Induce constipation in many patients
- Headache common.
- Do not use in patients on MAO inhibitors
- Typically dexamethasone
- Used to prevent cancer chemotherapy induced vomiting and PONV
- Unpleasant perineal sensations when given iv to awake patients
- Typically lorazepam to prevent cancer chemotherapy induced vomiting
- ↑ When I use a word: Nauseated/nauseous. Direct link: http://bmj.bmjjournals.com/cgi/content/full/332/7552/1271