Clinical Manual for Management of the HIV-Infected ... - myCME.com

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Lorazepam (Ativan) may be given as a 0.5mg
oral tablet one half hour before medications for
symptoms of anticipatory nausea. Patients with
anticipatory nausea develop significant nausea or
vomiting when even thinking about medications or
reaching for the medications.
Dronabinol (Marinol) may relieve nausea, especially
when nausea is accompanied by a loss of appetite.
This remedy is best tolerated by patients who have
tolerated inhaled marijuana. The starting dosage is
5mg 2 or 3 times daily.
5-Hydroxytryptamine (5-HT 3 ) receptor antagonists
such as dolasetron (Anzemet) 50 mg and 100 mg,
granisetron (Kytril) 1mg, and ondansetron (Zofran)
4-mg, 8-mg, and 24-mg tablets are highly effective
in relieving severe nausea and vomiting due to
chemotherapy and other causes. However, access to
these medications is limited by their cost. Their use
should be considered a short-term strategy.
Patient Education
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Nausea and vomiting can have many different
causes. Patients should let their health care providers
know if they are having these symptoms so that the
most likely cause can be determined.
Patients should stay nourished and well hydrated
even if they are having nausea and vomiting. Eating
small, frequent meals may be best tolerated, while
avoiding dairy products, greasy foods, and high-fat
meals.
Tell patients not to stop taking any of their
medications without first discussing it with their
health care providers. Many medications must be
continued despite nausea.
Many patients wonder whether they should take
their medicines again if they vomit after taking their
dose. Generally, the medicines are still in the system
unless the pills actually come back up. Patients
should call their health care provider if they have any
questions.
Ginger may help to relieve nausea. Ginger can be
taken in a variety of ways, including ginger ale, tea,
cookies, candies, or ginger capsules. Patients can
choose the form of ginger that works best for them.
References
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Section 5—Complaint-Specific Workups | 5–35
Sulkowski MS, Chaisson RE. Gastrointestinal and
Hepatobiliary Manifestations of HIV Infection. In:
Mandell GL, Bennett JR, Dolin R, eds. Principles
and Practice of Infectious Diseases, Vol. 1, 5th ed.
Philadelphia: Churchill Livingstone; 2000:1426-31.