Nausea and sickness in ME/CFS – two non-drug options that are worth considering | 29 June 2016

June 29, 2016

New guidance from the Royal College of Obstetricians and Gynaecologists adds further weight to the fact that two non-drug options – ginger and acupressure bands – can be helpful in relieving nausea.

BBC report:

These are non-drug options which are also worth considering when nausea occurs in ME/CFS.

However, whilst nausea and sickness can be a symptom of ME/CFS, it is important to exclude other possible medical explanations before doctors or patients conclude that this is ‘just another ME/CFS symptom'.

Medical information on acupressure bands:

More information on ginger (from Cancer Research UK):

Some people find ginger very helpful when feeling sick. People say it is particularly good for motion sickness. You can use ginger any way you like, for example as crystallised stem ginger. Or you can add freshly ground ginger to your favourite dishes, or to hot water or tea to make a soothing drink. You can try sipping ginger ale. Fizzy drinks sometimes help to reduce nausea too.

Researchers have been looking at using ginger alongside anti sickness medicines during chemotherapy. But the results so far have been mixed. So more research is needed.

Drug treatment options for nausea and vomiting. Source: patient information UK

* Cinnarizine, cyclizine, promethazine – these medicines belong to a group of medicines called antihistamines. The exact way that they work is not fully understood. It is thought that antihistamines block histamine 1 (H1) receptors in the area of the brain which creates nausea in response to chemicals in the body. They are thought to work well for nausea caused by a number of conditions including ear problems and motion (travel) sickness.

* Hyoscine – this medicine works by blocking a chemical in the brain called acetylcholine. It is a type of medicine called an antimuscarinic (or anticholinergic). It works well for nausea caused by ear problems and motion sickness.

* Chlorpromazine, haloperidol, perphenazine, prochlorperazine, levomepromazine– these medicines work by blocking a chemical in the brain called dopamine. They are useful for nausea that is caused by some cancers, radiation, and opiate medicines such as morphine and codeine. Prochlorperazine (or brand name Stemetil®) is one of the most used medicines for nausea. It works for many causes of nausea, including vertigo, ear problems and sickness in pregnancy.

* Metoclopramide – this medicine works directly on your gut. It eases the feelings of sickness by helping to empty the stomach and speed up how quickly food moves through the gut. It is often used for people with sickness due to gut problems or migraine. It is not usually used for more than a few days.

* Domperidone – this medicine works on the CTZ (an area of the brain known as the chemoreceptor trigger zone). It also speeds up the emptying of the gut. It is not usually used for more than a few days.

* Dexamethasone – this is a steroid medicine. It is a man-made version of a natural hormone produced by your own body. Dexamethasone has a wide range of actions on many parts of the body. The reason why it reduces nausea isn't clear.

* Granisetron, ondansetron, and palonosetron – these medicines work by blocking a chemical called serotonin (5-HT) in the gut, and the brain. Serotonin (5-HT) has an action in the gut and the brain to cause nausea. These medicines are useful for controlling nausea and vomiting caused by chemotherapy.

* Aprepitant and fosaprepitant – these are newer medicines and work by blocking a chemical that acts on neurokinin receptors in the body to cause nausea. They are sometimes called neurokinin-1 receptor antagonists. They are usually given to people on a certain type of chemotherapy.

* Nabilone – it is still not clear how this medicine works to control nausea. It is normally prescribed for people who are having chemotherapy.

Medicines for nausea are available as tablets capsules, liquids, suppositories and skin patches. Some are given as injections into the muscle or directly into the vein.

Some of these medicines are also available as tablets that dissolve in the mouth against the gum. They are called buccal tablets. These medicines come in various different brand names.

Dr Charles Shepherd
Hon Medical Adviser, ME Association

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