Nousea and Vomiting Mediciation 130509

7/27/2019 Nousea and Vomiting Mediciation 130509

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There are many different factors that triggernausea and vomiting. An unpleasant odour,illness and treatment or anticipation and stress

can provoke feelings which are unpleasant andcan make us ill.

There is a part of the brain known as thevomiting centre which receives and reacts tomessages from all our senses - sight, hearingsmell, movement and position.

A highly sensitive part of the vomiting centre, theChemo-receptor Trigger Zone (CTZ), has a rolein monitoring our internal body chemistry for

imbalances and abnormalities.

Nausea and vomiting are best managed bytreating the cause. However, in some cases, thecause is not reversible. There are a number ofmedications available to manage nausea andvomiting either temporarily or long term. Thesemedications work either by altering or blockingthe messages being sent to the vomiting centre inthe brain, or altering how the brain reacts to themessages.

Commonly prescribed medications

Metoclopramide (Maxalon, Pramin)

This is mostly used for nausea caused by theslowing of the gut, and in particular to offset theside effects of pain relief medication such asmorphine.

It is known as a ‘prokinetic’ medicine. It workspartly on the stomach, encouraging it to move itscontents through, and has some action in the

brain on the CTZ.

Domperidone (Motilium)

This is primarily a prokinetic agent with littleeffect on the vomiting centre in the brain.

It is useful where nausea and vomiting are due tosluggishness of the upper part of the gut.

Prochlorperazine (Stemetil, Stemzine)

This medication works on the CTZ part of thevomiting centre and is also useful for the nauseaof motion sickness. It has a number of side effectsso is generally limited to short term use.

Haloperidol (Serenace)

Commonly used in psychiatry, this medicationworks mostly at the CTZ and is very effective atrelieving nausea caused by medication and

chemical imbalances in the blood. It works in asimilar way to Prochlorperazine (Stemetil) buthas fewer side effects and can be used for longerperiods.

Medicines for nausea and vomitingFact sheet



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Lorazepam (Ativan)

Lorazepam is used for nausea due to anxiety andis part of the benzodiazepine (Valium) group ofdrugs. It is commonly used to overcome thenausea which results from anticipation prior to

chemotherapy, and is usually used together withother anti - nausea medication.

It comes as a tablet which can dissolve under thetongue as well as being swallowed.

Ondansetron* (Zofran)

Ondansetron blocks receptors in the gut andbrain that send messages to the CTZ andvomiting centre.

These receptors are usually activated bychemicals (cytokines) released from cells brokendown by chemotherapy or radiotherapy.

Zofran is often used in chemotherapy incombination with dexamethasone, but it cansometimes be effective in other situations as well.

Zofran comes as a wafer which can dissolveunder the tongue, a tablet, or an injection.

It has the side effect of being extremelyconstipating.

Other members of the same drug group are:Anzemet (Dolasetron), Kytril (Granisetron), andNavoban (Tropisetron).

Hyoscine butylbromide (Buscopan)

Buscopan is a medication which has two actions.It

reduces the secretions into the bowel; and suppresses and relieves the muscle spasms of

the intestines which cause colicky pain.

It is particularly useful for blockage of the bowel.

Hyoscine Hydrobromide (Hyoscine,

Scopolamine, Kwells, Travelcalm)

Like Buscopan, this drug works on the bowel butit is a more potent drying agent and is useful inmotion induced nausea and vertigo.

It does however have a tendency to causeconfusion in higher doses and its use is limited.

Dexamethasone

Dexamethasone is a steroid hormone used forreducing inflammation and swelling. It has adirect effect on the CTZ area of the vomitingcentre and is usually used alongside another antinausea medication like haloperidol, lorazepam or

ondansetron.

It is also effective in managing some of the causesof nausea and is used to manage:

increased pressure in the brain; early bowel obstruction; and chemotherapy-related nausea.

It can be taken as a tablet or given as an injectionunder the skin.

Side effects include:

trouble sleeping, irritability, euphoria; acid stomach/indigestion; and muscle weakness with longer term use.

Cyclizine

Cyclizine is an antihistamine. It works directly on

the vomiting centre, and is used for blockage ofthe bowel, pressure in the brain (used togetherwith dexamethasone), motion sickness or innerear problems.

Promethazine (Phenergan) is anotherantihistamine.



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Both need a special Pharmaceutical BenefitsScheme (PBS) Authority prescription from yourdoctor.

Levomepromazine** (Nozinan)

Also known as Methotrimeprazine.

Levomepromazine belongs to the antipsychoticgroup of drugs, but also has anti nausea andanalgesic properties.

It works at a number of sites and is called a‘broad spectrum’ medication. This is very useful ifthe cause of nausea is unclear or if there aremultiple causes of nausea or vomiting.

It needs careful monitoring because of itsinteractions with other medication.

It is very sedating, but may also causerestlessness.

Octreotide** (Sandostatin)

Octreotide is a synthetic hormone which reducesthe secretion of fluids into the bowel andincreases the amount of fluid the body absorbsfrom the bowel.

This is really useful when the bowel is blockedbecause it slows down the rate of fluid build upabove the blockage and means you will be lesssick, less often.

It is given as an injection under the skin. Itgenerally needs to be given three times a day orby continuous infusion.

When and how to take these medicines

Persistent symptoms require persistentmedication. Your doctor and nurse can adviseyou on the best times to take your medications.

Most medicines come in both tablet and injectionform. Sometimes the medications are best givenby injection under the skin to gain quick and

effective control of symptoms, for example whenyou are unable to a keep tablets down to absorbmedication from the gut.

Call your doctor or nurse

If you are unable to keep your medicationdown;

If you have any new symptoms includingnoticeable drowsiness, restlessness orconfusion; or

If your medication has no effect on how youfeel: sometimes it takes fine tuning to get goodrelief.

* Limited by the Pharmaceutical Benefits Schemeto chemotherapy and radiotherapy but often

prescribed for other reasons. Unfortunately theyare also very expensive.

** Available through hospitals under a SpecialAccess Scheme and generally needs to beprescribed by a Specialist doctor.

Related fact sheets

Nausea and vomiting

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Nousea and Vomiting Mediciation 130509