OTC Nausea, Vomiting, and Diarrhea

diarrhea: exclusions to self-treatment

• < 6 months of age

• frail patient ( <65 years old)

• persistent fever

• blood, pus, mucus in stool

• persistent vomiting

• immunosuppressed

• pregnancy

• chronic (> 4 weeks) /persistent diarrhea (2-4 weeks)

oral rehydration solution

indication: mild to moderate acute diarrhea for ages 6 months to 5 years

• 3-9% weight loss

drink 50-100 mL/kg over 3-4 hours

add 10 mL/kg for each subsequent loose stool after

pedialyte, hydralate, ceralyte

bismuth subsalicylate

pepto bismul

indication: acute diarrhea ages 12 and older

antimicrobial (bismuth oxychloride) and antisecretory (salicylic acid)

CIs: salicylate allergy, black stools, aspirin, anticoagulants, REYES

lactase

lactaid for digestion of milk products

loperamide

imodium

binds opiate receptor in gut wall —> inhibits prostaglandin and Ach release

indication: acute diarrhea ages 12 and older

4 mg initially orally followed by 2 mg after each loose stool

max = 8 mg/day

CI: children under 2 years old, dysentery

opioid effects

boxed warning: cardiac issues at high doses

probiotics

culturelle

ind: preventing and treating diarrhea (dietary supplement)

• lactobacillus rhamnosos

• Saccharomyces bouldardii

zinc

acute and persistent diarrhea in children

20 mg elemental 10-14 days for ages 6 months and older

10 mg elemental 10-14 days for younger than 6 months

ci: iron, tetracyclines

N&V exclusion criteria

• severe dehydration

• severe abdominal pain

• blood in vomit

• yellow skin

• head injury

• pregnancy (severe)

antihistamines for nausea

H1 histamine receptor antagonists for nausea that crosses the BBB

• Dimenhydrinate (Dramamine)

• Diphenhydramine (Benadryl Unisom)

• Meclizine (Antivert/Bonine) —> 1 hour before travel, vasodepressor effects

• Doxylamine(Unisom) —> safe for use in pregnancy

avoid in elderly (BEERS)

avoid in < 2 years old

phosphorylated carbohydrate solution

Emetrol

dextrose, fructose, and phosphoric acid

hyperosmolar solution, slows gastric emptying

indication: nausea and vomiting for ages 2 and older

ginger

supplemental therapy for nausea

• pregnancy and motion sickness

• bleeding risk

B6

pyridoxine

supplemental therapy for nausea