Prevention and Relief
Medicines for Nausea
Vomiting
When to Call a Medical Provider
When to Get Emergency Help

“Nausea, like pain, is very subjective. Some people sail through chemotherapy with no nausea, while others become so sick that they can’t tolerate it.”   —Jean Schneider, RN, case manager for Enclara Health

Nausea can range from a mild queasy feeling that passes in a few minutes to a more severe or lasting upset stomach. At worst, nausea feels like a strong urge to vomit, and sometimes vomiting does indeed follow.

Many health conditions and treatments can trigger nausea. Sometimes it develops because food doesn’t pass from the stomach to the intestines as quickly as it should. This is called delayed gastric emptying or gastroparesis, which means stomach paralysis. A blockage in the intestines can cause delayed gastric emptying. So can any condition or medication that decreases movement of material through the intestines. Opiate pain relievers are among the drugs that slow this movement.

Nausea is common in people receiving treatment for cancer. Overall, about 50% of them get this symptom—though it’s more common with stomach and breast cancer and with certain chemotherapy drugs.

“Nausea, like pain, is very subjective,” explains Jean Schneider, RN, case manager for Enclara Health. “Some people sail through chemotherapy with no nausea, while others become so sick that they can’t tolerate it.”

Also, people have different tolerances. “What one person thinks is severe nausea may be mild for someone else,” she says. What matters is how your loved one actually feels, not what anyone thinks they should feel.

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Prevention and Relief

It’s usually easier to prevent nausea than to relieve it. If you and your loved one watch for patterns, you may notice triggers, such as certain activities, foods, or medicines, and a warm stuffy room. These will help you prevent nausea. By keeping nausea in check, you may prevent vomiting, too.

• “Avoid strong odors,” says Schneider. Serve foods cold or at room temperature rather than hot. This cuts down on smells that might trigger nausea. Also, try to keep cooking odors out of her room.
• Consider the timing. If she tends to feel nauseated first thing in the morning, give her dry crackers, toast, or cereal then, before nausea starts. If it tends to happen between meals, offer smaller meals throughout the day, instead of a few larger ones. Give cool, clear drinks between meals instead of with meals. Chilled broth, apple juice, and grape juice are good choices. Encourage her to take small sips through a straw.
• Offer mild or bland foods, like potatoes, soft-boiled eggs, gelatin, and skinless chicken. Avoid spicy, sweet, greasy, and fried foods, and stay away from dairy, citrus, and caffeine.
• Don’t serve foods that she hasn’t tolerated well in the past. For instance, avoid foods she doesn’t like the taste of or has had an allergic or other uncomfortable reaction to. These foods can set off nausea, sometimes hours after eating, when the link may not be obvious.
• Let your loved one decide what and how much to eat. Illness may have changed how foods taste or smell to her. When she’s nauseated, avoid urging her to eat something she doesn’t want.
• Ask your loved one if she would like a quiet atmosphere while she eats or something entertaining, like television or music.
• Encourage her to sit up, or elevate her head and shoulders with pillows for one to two hours after eating.
• Take steps to manage pain and constipation; both can trigger nausea.
• If your loved one’s pain medicine causes nausea, ask her medical provider how to reduce this risk. “Some medications should be taken on a full stomach,” says Schneider. “Read the bottle or accompanying literature.” Clinical pharmacist Dave Krishna, RPh, adds that nausea associated with pain medicine can often be alleviated by taking the medicine with plenty of food or with milk.

How to Relieve Nausea

• Cool the room by opening a window or adjusting the heating. Or you could position a fan to blow lightly on his face. Place cool, damp washcloths on his forehead, neck, and wrists.
• Offer ginger ale and dry crackers, such as Saltines.
• Offer ice chips.
• Avoid jostling his bed or chair, because the motion may worsen nausea.
• Coach him on relaxation techniques. Some are described in the section on non-drug remedies for pain.

Over-the-counter (OTC) products that contain bismuth subsalicylate may help reduce nausea, too, by coating the stomach lining. “This ingredient is found in products such as Pepto-Bismol and Kaopectate,” Krishna explains.

If OTC products do not provide adequate relief, notify the medical provider and ask about trying a prescription medicine. This is especially important if nausea is severe enough to cause vomiting, which could lead to dehydration.

“When someone is experiencing nausea, there are different ways to address it, depending on the cause. Different nausea receptors are stimulated by different causes of nausea. So drugs used for chemotherapy-related nausea will not work for nausea caused by opiates or decreased motility,” explains Jessie Bell, RN.

You can help make nausea medicines most effective by following the doctor’s directions about when and how to give them. For example, some nausea medicines are meant to be taken before eating or before taking pain medicine.

“Nausea related to treatments such as radiation or chemotherapy can be prevented with medication taken on each day of treatment and for 24 to 72 hours thereafter,” says Krishna.

Medicines to relieve nausea work best if they’re taken as soon as the symptom starts. Make sure you know and stick to the right timing for your loved one’s specific medicines and situation.

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• If someone starts to vomit while lying down or having a seizure, turn his head to the side or roll him on his side, so he doesn’t choke.
• Encourage him to go ahead and vomit, rather than resist, because it may help him feel better, at least for a while.
• Suggest taking slow, deep breaths through his mouth between retching to ease nausea and maybe prevent more vomiting.
• Afterward, clean up quickly and ventilate the room to get rid of the smell, which can trigger more vomiting. Fresh air is best. Perfumed air fresheners and chemical smells can make nausea worse.
• Encourage your loved one to rinse his mouth and brush his teeth (or do it for him, if necessary) to get rid of the taste. Ask if he wants mouthwash or wants to gargle, if that’s possible. (Alcohol-based mouthwash may irritate the mouth. Another option is 1 teaspoon of baking soda dissolved in a glass of warm water.)
• Keep a towel and basin near your loved one’s bed or chair so that if he needs to vomit, he doesn’t try to reach the bathroom. Rushing to the bathroom may lead to falls and injuries.  

“If we attempt to eat solid foods when we are nauseated, we are likely to vomit, causing us to lose more fluid and electrolytes. We can live a long time without solid food, but we need fluids to sustain us.”   —Jessie Bell, RN, hospice nurse consultant with Enclara Health

After vomiting has passed, try offering small amounts of cool, clear liquids by the teaspoon, gradually increasing to a tablespoon unless vomiting starts again. Your loved one may find it easier to suck on ice chips or chips of frozen juice or broth rather than drinking. If clear liquids stay down, then introduce other liquids and solid foods as he feels better.

“When someone is experiencing nausea, I tell them I want to ‘rest their gut’ and stop eating solid foods until the nausea is under control,” says Jessie Bell, RN, hospice nurse consultant with Enclara Health. “I tell them they need clear liquids—dilute broth, juice, or Gatorade; gelatin; Popsicles; or weak caffeine-free tea. Throughout the day, encourage taking in small amounts of fluid that can be tolerated and kept down.

“If we attempt to eat solid foods when we are nauseated, we are likely to vomit, causing us to loose more fluid and electrolytes,” says Bell. “We can live a long time without solid food, but we need fluids to sustain us.”

As the nausea and/or vomiting is treated and subsides, reintroduce bland foods, such as plain toast, crackers, plain rice, applesauce, bananas, and plain rice cereal. Animal proteins are some of the most difficult foods to digest, and they take longer to digest. So avoid giving meats until the nausea is completely gone. Otherwise, the patient may be more likely to vomit.

• Your loved one can’t keep down clear liquids for 12 hours or more.
• She can’t take her nausea medicines for any reason.
• He vomits more than two times in two hours, or vomits for more than two days.
• Your loved one has signs of dehydration: greater thirst, less urination, dark urine, dry mouth, sunken eyes, lethargy, dizziness or lightheadedness, confusion, muscle weakness or cramping, or skin that doesn’t return to its usual shape when pinched.
• She has an unusual increase in urination, which may be clear or pale yellow. This could be a sign of diabetes and could put her at risk of dehydration.
• He has unusual pain, stiff neck, or severe headache associated with nausea.

Helpful Information for Medical Providers

1. How often he has nausea or vomits.
2. How much he vomits.
3. When it happens and what seems to cause it.
4. How long it lasts.
5. What you’ve tried and what makes it better or worse.
6. Which medicines she is taking, including medicines for nausea.
7. What other symptoms she has, which may suggest what’s causing the nausea.

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When to Get Emergency Help

• There’s blood in the vomit or a substance that looks like coffee grounds. (This is likely blood.)
• Your loved one has pain or other discomfort with vomiting. Abdominal pain could mean a bowel obstruction or appendicitis.
• He started vomiting after a head injury, such as from a fall.
• She has projectile vomiting so forceful that it shoots away from her body.