Nausea happens. In fact, nausea is responsible for 4.8 million visits to the Emergency Department in the United States annually . There are many common causes including stomach viruses, vertigo, morning sickness, common reactions to antibiotics or medicines or vitamins, disagreeable food–you name it. Of course, there are serious causes of nausea including heart attacks, surgical abdominal issues, or head injuries/bleeding, but these are not often the case.
Most of my patients sit at home for a time without any remedies when they have nausea. They try to nurse themselves back to hydration with sips of water or soda, only to vomit it all back up and drive to the ER (or call 911…). “What have you tried?” I’ll ask.
“Pedialyte,” or “Gatorade,” if they are thinking ahead to try to stay hydrated. These are great options if you are able to keep anything down, but what if you’re so nauseous you can’t keep anything down and you can’t go to the doctor? Are there any over-the-counter medicines or home remedies?
Ginger root is an ancient treatment used in Asia and the Middle East to treat nausea. It has been recently well-studied by science and found to be significantly better than placebo in treating nausea. One study found it to be nearly as effective as a medication related to promethazine (discussed above).
The way I recommend taking it is via Tea. To prepare a tea, you can use fresh sliced ginger or even powder if you’re in no condition to go to the grocery store. If using the powder sprinkle a small amount into hot water, if slicing fresh–slice thin to extract as much of the flavor and compounds into the tea. You’ll add the ginger to a cup of hot water and add a bit of honey for flavor. Crystallized/sweetened ginger candies are really great tasting, if not a bit spicy, and will do the trick as well and can fit in your bag or purse.
The newest and most surprising entrant is inhaled isopropyl (rubbing) alcohol. A study published in the Annals of Emergency Medicine showed that inhaled isopropyl alcohol pads, when given to acutely nauseous patients, had a significant improvement in nausea symptoms vs folks who inhaled plain saline. It was not compared to other conventional nausea medications. Anecdotally, it seems to work quickly but wear off within 10 minutes or so in my patients when I have used this. But keep in mind it is exceedingly cheap, apparently without side effects, can be re-administered (i.e. huffed) when nausea returns, and is RAPID. I want to be clear, it is not to be drank/ingested, but the vapors are to be inhaled.
But what if you’re really sick and this stuff isn’t working? What are the medications and how to they work? I’m glad you asked!
Fortunately, there are great medication options, but most are prescriptions. Phenergan (promethazine) was approved for medical use in 1951 as a first-generation antihistamine (1) and was later found to have anti-emetic (anti-nausea) properties and sedative properties. We administer it in the ER in IV or intramuscular form, and will often prescribe it via oral tablet or rectal suppository administration. If you’re so nauseous that you can’t keep down a tablet, believe me, a suppository sounds remarkably good! It does have notable side effects, most bothersome for most people is sedation, but sometimes people develop weird facial movements called Tardive Dyskinesia if taken for a long period of time, and very rarely patients have developed necrosis and gangrene of tissues when the medication has been inadvertently injected into an artery.
Next came along the miracle drug Zofran (ondansetron) in 1990 which revolutionized nausea treatment. It works via blocking the serotonin 5-HT3 receptor in the vagus nerve and brain. It works wonderfully for most types of nausea, although probably doesn’t work as well for concussive nausea or motion sickness. Importantly, it comes in dissolving tablet form like a candy on your tongue, and is finally generic and relatively cheap (about $1-2 per tablet in the U.S.). It has far fewer side effects and is generally the go-to medication most physicians will prescribe for their patients.
So the next time you are invariably nauseous, prepare yourself some ginger tea and huff (snuff?) some isopropyl alcohol to help with symptoms, and let us know how it goes.
–DrMedicineMan
This site and journal entries are intended to provide general medical discussion and knowledge. If you think you may be having a serious medical condition, please consult with your physician or go the nearest ER.
Sources:
- “Promethazine Hydrochloride Monograph for Professionals”. Drugs.com. American Society of Health-System Pharmacists. Retrieved 13 April 2019.
- “The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy”. Integr Med Insights. 2016; 11: 11–17.
- “Can Inhaled Isopropyl Alcohol Alleviate Nausea?” Medscape. Retrieved 13 April 2019.
- “Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial.” Annnals of Emergency Medicine. July 2016 Volume 68, Issue 1, Pages 1–9.
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