Managing Nausea and Vomiting

Nausea and vomiting can be side effects of drugs like epoprostenol and treprostinil. They can also be caused by the heart failure common in PH. Vomiting is how our body gets rid of food it thinks should not be in the stomach. It is stimulated by sensory receptors in the wall of the stomach including stretch receptors that indicate when the stomach is too full, and chemoreceptors that detect possible toxins and poisons. The emetic center in the brain responds by causing a wave of reverse peristalsis in the stomach muscles, expelling the contents.

While vomiting is unpleasant, it is only dangerous when it is severe or prolonged. The main danger is loss of fluids and minerals (magnesium, calcium and potassium). This can cause dehydration, weight loss, and an electrolyte imbalance. If too much fluid is lost, the situation can become dangerous and intravenous fluids and electrolytes may be needed to reverse the imbalances. Nausea, early satiety (feeling over-stuffed) and lack of appetite can be symptoms of worsening right-side heart failure due to progression of PH. If you have prolonged nausea or vomiting, contact your doctor. Also, bosentan and abrisentan are metabolized through your liver, so if you are taking these meds and experience nausea and vomiting you should alert your healthcare provider.

Ways to avoid nausea:

• Don’t eat large meals that fill your stomach, drink large amounts of liquids with meals or drink too many carbonated beverages.
• Avoid greasy and fatty foods. Fat causes food to remain in the stomach longer, increasing the chance you may vomit.
• When you feel nauseated, nibble on high-carb foods such as crackers, pretzels, dry toast and soft bread.
• Cold, non-acidic liquids often help to settle a stomach (try small sips of ice water, ice chips, iced herbal teas, iced tea and small tastes of fruit sorbets).
• Sit up when you eat, and don’t lie down immediately after eating.
• Avoid any food that you know causes gas or “repeats” on you (makes you burp).
• Place an ice pack on the back of your neck. The gel packs used to cool Flolan® work well.
• Open windows and let in fresh, cool air. Stale or smoky air makes nausea worse.
• Keep your teeth and tongue brushed, your teeth flossed and your mouth rinsed. This will help keep bad flavors and odors from developing.