What is the best medication for nausea

1. About metoclopramide

Metoclopramide is an anti-sickness medicine (known as an antiemetic). It's used to help stop you feeling or being sick (nausea or vomiting) including:

• after radiotherapy or chemotherapy (treatment for cancer)
• sickness you may get with a migraine
• if you've had an operation
• at the end of life (palliative care)

Metoclopramide comes as tablets or a liquid that you swallow. It can also be given as an injection, but this is usually given in hospital or by a member of a care team visiting you at home.

It is only available with a prescription.

For migraines, you can also get metoclopramide combined with a painkiller with a prescription.

2. Key facts

• You'll usually only take metoclopramide for a short time (up to 5 days).
• The most common side effects are feeling sleepy (drowsy) and diarrhoea
• Avoid drinking alcohol with metoclopramide. It will make you feel more sleepy.
• Brand names for combination migraine treatments include Migramax (metoclopramide with aspirin), and Paramax (metoclopramide with paracetamol).

3. Who can and cannot take metoclopramide

Metoclopramide can be taken by most adults and children aged 1 year and over.

Metoclopramide is not suitable for some people. Tell your doctor or pharmacist if you:

• have had an allergic reaction to metoclopramide or any other medicines in the past
• have ever had bleeding from your stomach or intestines
• have kidney or liver problems
• have a slow heart beat (bradycardia)
• have a tumour on your adrenal gland
• have a rare inherited blood disorder such as porphyria, methaemoglobinemia, or NADH cytochrome-b5 deficiency
• have ever had involuntary muscle spasms when taking medicines such as metoclopramide or antipsychotics
• have Parkinson's disease, or epilepsy, or a history of fits or seizures
• are trying to get pregnant, you're already pregnant or if you're breastfeeding

4. How and when to take it

If you or your child has been prescribed metoclopramide, follow your doctor's instructions carefully.

You can take metoclopramide with or without food.

Swallow the tablets whole, with a drink of water.

For the liquid, use the plastic syringe or medicine spoon that comes with your medicine to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

How much to take

Doses can vary, depending on why you need metoclopramide. Always follow your doctor's instructions.

The usual adult dose is 10mg, taken up to 3 times a day. Your doctor may recommend a dose of up to 30mg, if needed.

Doses are lower for adults who weigh less than 60kg, and for people with a liver or kidney problem.

If your child is prescribed metoclopramide, the doctor will use your child's age and weight to work out the right dose.

Try to spread your doses evenly over 24 hours. If you take it 3 times a day, then take a dose every 8 hours.

Wait at least 6 hours between each dose, even if you are sick (vomit). This is to avoid a possible overdose.

What if I forget to take it?

If you forget to take a dose of metoclopramide, skip the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it might help to set an alarm to remind you.

What if I take too much?

Taking 1 extra dose of metoclopramide is unlikely to be harmful, however, taking more than this can be dangerous.

Immediate action required: Call 999 or go to A&E now if:

• you take 2 or more extra doses of metoclopramide, even if you feel well
• you get muscle spasms, shaking, tremor, drowsiness, confusion or hallucinations (seeing things that are not there).

Do not drive yourself. Take the metoclopramide box or leaflet inside the packet plus any remaining medicine with you.

5. Side effects

Like all medicines, metoclopramide can cause side effects, although not everyone gets them.

These common side effects happen in more than 1 in 100 people. These are usually mild and go away by themselves.

Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

• feeling sleepy and a lack of energy
• low mood
• feeling dizzy or faint – this could be a sign of low blood pressure
• diarrhoea

Serious side effects

Some people may have serious side effects when taking metoclopramide, but these are rare.

Stop taking metoclopramide and tell your doctor if:

• your muscles or eyes start moving in an unusual or uncontrolled way
• you have had a seizure or fit (this side effect can happen if you have epilepsy)

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to metoclopramide.

Immediate action required: Call 999 or go to A&E if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you're wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of metoclopramide. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

• feeling sleepy and a lack of energy – do not drive or use tools or machinery. Do not drink alcohol, as it will make you feel more tired. If these symptoms get worse or last longer than a few days, talk to your doctor.
• low mood – this should pass after a couple of days but if it does not, speak to your doctor as you may need a different type of anti-sickness medicine.
• feeling dizzy or faint (low blood pressure) – this should get better after a few days as your body gets used to the medicine. Do not drive, ride a bike or use tools or machinery. Sit or lie down until the symptoms get better. Do not drink alcohol, as this can make the symptoms worse. Speak to your doctor if the problem does not go away after a couple of days or gets worse.
• diarrhoea (with high doses of metoclopramide) – drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

7. Pregnancy and breastfeeding

There's no evidence that metoclopramide will harm your unborn baby. However, for safety it's best to take it for the shortest possible time and at the lowest dose that works for you.

There are other treatments for morning sickness that your doctor will try first. However, they may prescribe metoclopramide if these other treatments do not work.

Read about treating morning sickness on the Best Use of Medicines in Pregnancy (BUMPS) website.

Metoclopramide and breastfeeding

Metoclopramide passes into breast milk in small amounts.

If your baby was premature, had a low birth weight or has health problems, speak to your doctor before taking any anti-sickness medicine when breastfeeding.

If you take metoclopramide while breastfeeding and notice your baby is not feeding as well as usual, seems unusually sleepy, or you have any other concerns about your baby, talk to a health visitor or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

8. Cautions with other medicines

Some medicines and metoclopramide interfere with each other. This can increase your chance of having side effects.

Tell your doctor or pharmacist if you're taking:

• medicines for Parkinson's disease, such as levodopa
• medicines that make you sleepy (drowsy) including diazepam and amitriptyline
• any other anti-sickness medicines (antiemetics)

Mixing metoclopramide with herbal remedies

Some herbal remedies can make your side effects worse. Speak to a pharmacist before taking any herbal supplements.

Important: Important

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does metoclopramide work?

There's an area in your brain called the vomiting centre, which controls when you feel sick or are sick.

It can be triggered when it receives messages from an area of the brain called the chemoreceptor trigger zone (CTZ).

Metoclopramide works by blocking messages between the CTZ and the vomiting centre. This helps reduce feelings of sickness (nausea) and helps stops vomiting.

How long does it take to work?

Metoclopramide tablets and liquid usually start to work after 30 to 60 minutes.

How long will I take it for?

How long you take metoclopramide for depends on why you're taking it.

Metoclopramide is usually only prescribed short term. You will generally take it for up to 5 days maximum.

For migraine you will only take it when you have symptoms. You will not need to take it every day.

For nausea and vomiting caused by chemotherapy or radiotherapy, take it for as long as your doctor tells you to.

Talk to your doctor or pharmacist if you're unsure how long you need to take metoclopramide for.

Can I drink alcohol with it?

Do not drink alcohol while you're taking metoclopramide.

Alcohol and metoclopramide together can make you sleep very deeply and you may have difficulty waking up. This can be very dangerous.

Is there any food or drink I need to avoid?

Except for avoiding alcohol, you can eat and drink normally while taking metoclopramide.

Will it affect my fertility?

There's no firm evidence that metoclopramide will affect fertility in either men or women.

Can I drive or ride a bike?

Do not drive a car, ride a bike, use tools or machinery if metoclopramide makes you sleepy, affects your vision, or makes you feel dizzy, clumsy or unable to concentrate or make decisions.

This may be more likely when you first start taking metoclopramide, but could happen at any time (for example, when starting another medicine). It's best to wait until you know how the medicine affects you.

It's an offence to drive a car if your ability to drive safely is affected.

It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Find more information on the law on drugs and driving on GOV.UK.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking metoclopramide.

Can lifestyle changes help with nausea or vomiting?

There are some lifestyle changes that can help with feeling or being sick:

Do

• get plenty of fresh air

• distract yourself – for example, listen to music or watch a film

• take sips of a cold drink – some people find fizzy drinks best

• drink ginger or peppermint tea

• eat foods containing ginger – such as ginger biscuits

• eat smaller, more frequent meals

Don’t

• do not eat or cook strong-smelling food

• do not eat hot, fried or greasy food

• do not eat quickly

• do not have a large drink with meals

• do not lie down soon after eating

• do not wear clothes that are tight around your waist