BREAKTHROUGH NAUSEA AND VOMITING In cases of uncontrolled post-op emesis that traditional PONV drugs don't curb, you can try these alternative therapies that come from other fields besides anesthesia.

Off-Label Drug Use
3 Tips to Treat Intractable PONV

You probably use Zofran (ondansetron), Reglan (metoclopramide) and Decadron (decamethasone) to prevent and treat post-operative nausea and vomiting, but for those intractable cases of PONV when those antiemetics don't work, here are a few alternative treatments — including a couple from fields besides anesthesia — that might be worth a try:

• Emend (aprepitant) 80 mg oral or film or 150 mg IV. Emend antagonizes the NK1 receptors and can prevent vomiting from a single dose. It works for 48 hours.
• Ativan (lorazepam) 2 mg sublingual. Ativan is a sedative that is most generally used to treat anxiety, but also works well to treat post-operative nausea and vomiting. It is known by oncologists as a treatment to reduce nausea, vomiting and anxiety in patients undergoing chemotherapy.
• Zyprexa (olanzapine) 5 mg po. When everything has failed, patients with intractable nausea and vomiting undergoing chemotherapy swear by this well-known anti-psychotic drug's antiemetic properties. The mechanism remains unclear, but it appears that olanzapine blocks multiple types of receptors that induce both nausea and vomiting. When all else fails, Zyprexa might be worth a try.

John Hsu, MD
Presbyterian Hospital
Whittier, Calif.
[email protected]