Nausea : Causes and Treatment ~ Daily OTC

Nausea is unpleasant and something everyone has experienced. Yet while nausea and vomiting are common symptoms, they are not conditions in their own right – and the best way to stop them is to work out the cause and provide the right OTC or prescription treatment.

Common causes of nausea and vomiting include infection, emotional or physical stress, alcohol, food poisoning, overeating or a reaction to certain smells. While nausea and vomiting are common, patients who experience symptoms for more than two days should be referred to the pharmacist, as should children under two years as they are at risk of dehydration.

Planes, boats and automobiles

Motion sickness, or travel sickness, is an extremely common cause of nausea and vomiting. It occurs when repetitive small movements cause the brain to receive mixed messages; the eyes tell the brain one thing while the balance mechanisms of the inner ear tell it something different. This is most common at sea, but can also happen in cars or planes.

The resulting confusion leads to early symptoms such as hot flushes and paleness, which usually progress to sweating, nausea and vomiting. Children are commonly affected and it tends to be something they grow out of in time. Motion sickness is more likely to be experienced by women than men, especially if they are pregnant or are having their period. People who suffer from migraines are also more susceptible to motion sickness.

The sensation of nausea can be made worse by strong smells, such as petrol or food, or by attempting to focus the eyes on a nearby object such as when reading book or a map. If exposed to the stimulus over a prolonged period of time (such as ship travel on a cruise), symptoms of motion sickness tend to improve as the body adapts to the conditions.

The best way to avoid suffering from motion sickness is to take travel sickness pills before the symptoms begin and to avoid large meals or alcohol before travel.

Morning sickness

Nausea occurs in up to 90 per cent of pregnancies, with between 25 and 55
per cent of women experiencing vomiting. Contrary to popular belief, nausea and vomiting can occur at any time and are not just confined to the morning. Nausea usually presents in the early weeks of pregnancy, and only around one in 10 women will still experience symptoms after 16 weeks. Woman should be reassured that nausea in pregnancy is normal, and that it will pass with time.

Occasionally, women can experience excessive, persistent vomiting. If the woman is really poorly and unable to keep any food down she should be advised to visit her GP as she may be suffering from hyperemesis and need anti-sickness medication or even hospitalisation.

Drugs and nausea

A large number of drugs have nausea as a possible side effect, although it often eases over time as the body becomes accustomed to the new medication.

If you suspect the medicine is causing nausea refer the patient to the pharmacist, as there may be steps to minimise symptoms, such as taking the medicine with food, or trying a different drug.

Commonly-used drugs that often cause nausea include:
• aspirin
• NSAIDs
• antibiotics
• oestrogens
• steroids
• opioid analgesics.

Prescription medication is available to treat the nausea and vomiting caused by chemotherapy in cancer patients.

Nausea as a medical emergency

Immediate medical attention should be sought if the patient has nausea and vomiting and any of the following symptoms:
• blood in the vomit
• severe headache or a stiff neck
• lethargy, confusion or decreased alertness
• severe abdominal pain
• a temperature greater than 38.3°C
• rapid breathing or pulse.

Digoxin toxicity may present as nausea and/or vomiting so it is extremely important that any patient taking digoxin, especially if elderly, is referred to the pharmacist immediately if they experience either of these side effects.

Treating nausea

A number of products for nausea are available to buy over the counter. They vary according to the cause of the symptoms, with the biggest category aimed at motion sickness. A number of different brands exist and they contain different active ingredients.

Hyoscine hydrobromide is a popular choice as it only needs to be taken 20 minutes before travel and is considered to be less sedating than other preparations. It has a short duration of action though, so another dose may be required six hours after the initial dose. Possible side effects include drowsiness, blurred vision, dry mouth, urinary retention and constipation. Hyoscine should not be used by people with glaucoma and should be used with caution in patients with urinary problems, heart disease or high blood pressure.
Other drugs used in travel sickness preparations include the antihistamines meclozine and cinnarizine. Both of these have a longer duration of action than hyoscine but commonly cause drowsiness and need to be taken one or two hours before travel. Promethazine can be used but it is very sedating.

Nausea associated with migraine can be treated over the counter either with prochlorperazine or with buclizine (in combination with paracetamol and codeine). Prochlorperazine can only be sold for use to adults over 18 years of age who have previously been diagnosed with migraine by a doctor.

If the nausea is associated with indigestion then you could consider selling certain indigestion remedies.

Products containing bismuth compounds are an option, which work by coating the wall of the stomach, thereby protecting it from further irritation. They should not be taken by children under 16 or by people taking aspirin. Products containing domperidone can help speed up the process of digestion thus reducing nausea, but are only available over the counter for customers older than 16 years.

There is no effective OTC treatment for vomiting. Sufferers should simply be advised to drink gradually larger amounts of clear liquids and to avoid solid food until the vomiting has ceased. If the customer has been vomiting for more than 24 hours, you should recommend the use of rehydration salts.

Preventing vomiting

A number of steps can be taken to reduce nausea and prevent vomiting.

• You should advise customers who are feeling nauseous to eat small meals at frequent intervals instead of three large meals a day.

• Alcohol should be avoided and they should drink between, rather than with, meals. After eating it is best to rest for a while in an upright position.

• Eating cold food will avoid nausea triggered by the smell of cooking or hot food. You could also suggest customers try to eat slowly when feeling less nauseous, and to only eat plain foods (such as dry toast or biscuits) that are easy to digest.

• Motion sickness may be relieved by getting some fresh air (opening the window in a car or going on the deck of a boat) and by looking ahead at the horizon. Distraction with music or using relaxation techniques can also help

References

http://www.emedicinehealth.com/vomiting_and_nausea/article_em.htm

http://en.wikipedia.org/wiki/Nausea