Noncytotoxic drug-induced nausea and vomiting in adults

Nausea and vomiting are common adverse effects of many drugs (eg opioids, tramadol, oestrogens, metformin, antibiotics such as erythromycin and metronidazole), but they can also be a sign of drug toxicity (eg digoxin).

Take a detailed medication history, including prescription and over-the-counter drugs, complementary and alternative medicines, and illicit drugs (particularly cannabis). Suspect any drug that was started or increased in dose around the time that symptoms began. Even previously tolerated doses of drugs may cause symptoms if metabolic or excretory pathways are compromised. Polypharmacy may also cause nausea and vomiting. Consider pharmacist review if noncytotoxic drug-induced nausea and vomiting is suspected.

Chronic cannabis use is a well-recognised cause of chronic nausea and cyclical vomiting syndrome; see Cannabinoid hyperemesis syndrome.

If possible, stop the causative drug or reduce its dose. If necessary, an antiemetic drug can be used for symptom relief (see Antiemetic drugs in adults for dosage and precautions).