Not without Enquiring

Babys, infants and younger school children vomit relatively frequently as their stomach and bowels react very sensitively. In most cases this is no cause for concern, especially if they do not vomit more than once and the child is in no other way ill. Possibly the child had been drinking too fast or perhaps eaten too many different things at once. It also can end up in vomiting, if infants or small children have a violent tantrum. Vomiting can often be the body’s sensible method of protecting itself in order to quickly eliminate poisonous substances – for example from spoiled foodstuffs. In many cases, however, it is an unpleasant, energy-sapping symptom of an illness or the consequence of a therapy.

If a customer asks for some medication against nausea and vomiting at the pharmacy, PTA and the pharmacist should have him describe the exact symptoms and circumstances. Otherwise it cannot be decided whether a visit to the doctor instead of self-medication is called for. Temporary vomiting is as a rule harmless. However, in the case of repeated strong vomiting, spasmodic pain or recurrent pain on the same spot, PTA and the pharmacist should at all events send the customer to see a doctor. A question they could ask their customer is, if he had been abroad recently. The vomiting may possibly be the consequence of an infection contracted abroad.

What is also important is the question about colour and consistency of the vomit. Normally, pieces of food of the last meal can still be recognized in it. It is only critical if the vomit is red or black like coffee grounds. In the first case fresh blood is contained, in the second case blood that had partially been digested. If the vomit tastes bitter and is yellowy-green, it contains gall. In all these cases it is imperative that the customer be examined by a doctor. If children start vomiting after a fall or an accident with accompanying severe tommy ache and the child is apathetic, parents should consult a doctor too.Generally, breast-fed Babys, small infants, and geriatrics are high-risk patients as they are not able to compensate for the loss of fluid and electrolyte which goes along with vomiting. Whenever they had vomited repeatedly, they need to receive medical attention.

Self-medication can be used as a therapy particularly in the case of travel sickness and slight morning sickness. As a rule, nausea and vomiting are limited to the duration of the journey. Whoever knows that they are prone to travel sickness should take an antiemetic half an hour before onset of the journey. Rektal application delays the absorption so that the suppository should, if possible, be inserted two hours before starting the journey. Once the travel sickness has started, it is harder to keep it in check. In the case of journeys of a longer duration, it is necessary to repeat the treatment in the prescribed intervals, until the daily maximum dose has been reached or the journey ended.

For self-medication of nausea and vomiting, first generation H₁-antihistamines such as dimenhydrinate and diphenhydramine are the drugs of choice. Depending on the dosage form, dimenhydrinate is also suitable for infants. Patients should be told that the medication brings on tiredness. Further side effects could be dizziness and muscle weakness as well anticholinergic effects such as dry mouth, an increased intraocular pressure and problems when urinating. While taking the medication, patients should not drink any alcohol, as it can increase the effect and side effects. H₁-antihistamines are contraindicated in the case of angle closure glaucoma, prostatic hyperplasia, bronchial asthma, epilepsy as well as during breast-feeding. They should not be used during an ongoing therapy with psychopharmaceuticals, hypnotics, medication with an anticholinergic effect and antiarrhythmics.

If you look at the instruction leaflet of travel medicaments or antiemetics, some producers advise against taking any at all during pregnancy. Before recommending any preparation to an expectant mother, PTA and pharmacists should read the instruction leaflet first to avoid making her uncertain. According to Embryotox, the internet portal of the Charité University Medicine Berlin, diphenhydramine can be used during the entire duration of the pregnancy; the temporary use of dimenhydrinate is also acceptable according to Embryotox. However, neither of the substances should be used in the third trimester in the case of premature contractions as they could increase these.

For patients who prefer herbal medicines, ginger preparations are a good remedy for nausea. They are suitable for children as from six years of age. The effect is based on an antagonism at central 5-HT₃-receptors. In some sensitive persons, ginger can cause heartburn as a side effect. In the case of cholelithiasis (gallstones), ginger is contraindicated. According to Embryotox, ginger can be taken in the usual dosage during pregnancy. In its instruction leaflet, the producer of the product Zintona^® does, however, advise against taking it when suffering from morning sickness and during breast-feeding.