Nausea and vomiting

About nausea
How to describe nausea to your doctor
Medications used for nausea
Other suggestions

About nausea

Associated drugs: most HIV medications include nausea as a potential side effect

Man being sick Most HIV medications include nausea as a potential side effect.

Nausea (feeling sick), and vomiting (being sick), is quite common when starting a new combination. However, for most people, this improves after a few days or weeks as your body gets used to the drugs.

Using an anti-emetic (anti-sickness) pill regularly in the first few weeks is often all that is needed. If one anti-emetic does not work, it is worth trying others. Some anti-emetics work by emptying your stomach more quickly and others by stopping the signals that tell your brain that you feel sick.

If the nausea does not improve, you may need to change to other anti-HIV medication. There may also be an underlying cause not related to HIV medication which should be investigated.

If you are taking abacavir and you are feeling nauseous or vomiting, then contact your clinic straight away to rule out a hypersensitivity reaction.

How to describe nausea to your doctor

How often each day do you feel sick, or are you sick?
How many days a week does this happen?
How long does the feeling of nausea last?
Has this affected how much you can eat or drink?
Do you feel more tired or weak as a result?

Medications used for nausea

Domperidone (Motilium): 10-20mg every 4-8 hours. Suppositories 30-60mg every 4-8 hours are a good alternative to swallowing pills when you are feeling sick.

Metoclopramide (Maxolon): usually 10mg, 3-times a day. There are slow-release versions, which can be used twice a day, including Maxolon SR and Gastrobin Continuous; however, they should not be used in anyone under 20 years old. Be aware of dystonic reactions (twitching movements) at higher doses.

Prochlorperazine (Stemetil): usually 5-10mg, 2-3 times daily. A special preparation is available called Buccastem, 1 or 2 tablets are placed between the upper lip and gum and left to dissolve; not having to swallow more pills is useful when you are feeling sick.

Haloperidol: 1.5mg daily or twice daily where nausea is severe. Particularly useful as can be taken at night to avoid early morning nausea.

Sometimes these medications have side effects themselves that you should ask your doctor about.

Where other medications and lifestyle changes have failed and nausea continues, then medications that are normally reserved for patients receiving very strong chemotherapy may be prescribed.

These include granisetron, ondansetron and tropisetron and they are highly effective.

Other suggestions

If changing your medication is not an option and the nausea is continuous, then any of the following suggestions can help.

Eat smaller meals and snack more frequently rather than eating just a few larger meals
Try to eat more bland foods and avoid foods that are spicy, greasy or strong smelling
Leave some dry crackers by your bed and eat one or two of them before getting up in the morning
Ginger is very helpful and can be used as capsules, ginger root powder or fresh root ginger peeled and steeped in hot water
If cooking smells bother you then open the windows while cooking and keep the room well ventilated
Microwave meals prepare food quickly and with minimum smells, so you can eat a meal as soon as you feel hungry. Getting someone else to prepare your meals can help, if this is possible
Don’t eat in a room that is stuffy or that has lingering cooking smells
Eat meals at a table rather than lying down and don’t lie down immediately after eating
Try not to drink with your meal or straight after: it is better to wait an hour and then sip the drink slowly
Try eating cold rather than hot food or let hot food cool well before you eat it
Peppermint is also useful and can be taken in tea, sweets or chewing gum
Acupressure and acupuncture can also be very helpful, anti-nausea acupressure bands are available from most chemists
Try to avoid things that irritate the stomach such as alcohol, aspirin and smoking