An HIV Information & Educational Resource Site

or, "What should I do if I am nauseated or my medications are making me want to throw up?"

Side effects from medications are pretty common, but fortunately they are generally pretty mild and can be remedied with relatively easy treatments.  As medicine makes progress in the treatment of HIV and AIDS, the newer medications are generally easier to take and less sickening than some of the older treatments.  Additionally as more and more treatments are found, it becomes easier and easier to find treatments that suit all patients much better.

See below for nausea and vomiting.  The most important thing to do about side effects is to report them to your healthcare provider promptly and completely.  If your healthcare provider is aware of your symptoms and problems, your provider can provide recommendations about treatments and changes in your treatment that can decrease or even eliminate the symptoms that you are dealing with.  Please note that the information below should not come before the advice of your healthcare provider because only that person knows all of your medications and all of your conditions.

Nausea and Vomiting
Possible Causes
HIV Drugs
saquinavir (Fortovase)
atovaquone (Mepron)
sulfamethoxazole/trimethoprim (high dose)
AIDS-related illness
cytomegalovirus gastritis
disseminated MAC
toxoplasmic encephalitis
Food poisoning
E coli
Other drugs
cancer chemotherapy
TB medications
liver inflammation (hepatitis)
pancreas inflammation (pancreatitis)
peptic ulcer disease
brain abnormalities (tumors)
Explanation and Possible Solutions
Important:  As one can see from the list of possible causes to the left, there are many serious causes of nausea that must be considered especially hepatitis and pancreatitis.  It is critical that all nausea and especially nausea with vomiting that persists and/or worsens should be reported to your healthcare provider promptly.

If the nausea meets the following conditions, several treatments can be considered (see below):
1.  The nausea must be considered "mild."  For nausea to be considered mild, one must be able to eat and drink so that one's weight is maintained and the person urinates normally.
2.  The nausea must not be getting worse.
3.  The nausea is not associated with any other symptoms such as fever, headache, abdominal pain, or yellow pigmentation of the eyes or skin (jaundice)
4.  It is clearly associated with dosing of a medication
5.  Vomiting is infrequent (1-2 times per day maximum) and does not contain blood or material that looks like coffee grounds
6.  The nausea must not be constant.  There must be substantial amounts of time when there is no or minimal nausea.

Treatments that may be considered include the following:
1.  Promethazine (Phenergan).  This medication may be taken in pill or capsule form, suppository, or as a shot or by vein.  It works on the brain's nausea center.  Ideally it should be taken before the medication that causes nausea to PREVENT the nausea.  It is easier to prevent nausea than to treat it once it has developed.  The suppository form is not much fun to administer but sometimes it is necessary because sometimes the person is too sick and will throw up pills.  This is a prescription drug and it may cause sedation and rarely muscle and nervous system problems.
2.  Prochlorperazine (Compazine).  In many ways this drug is nearly identical to promethazine (see above).
3.  Metoclopropamide (Reglan).  In many ways this drug is nearly identical to promethazine and perclorapzine (see above).
4.  Odansetron (Zofran) This medication also works on the brain's nausea center.  It is used for persons who have nausea from cancer chemotherapy, but it works for other types of medication-induced nausea also.  However, it is relatively costly.  It is very well tolerated.
5.  Granisetron (Kytril)  This medication is very similar to odansetron (see above)
6.  Hydroxyzine (Vistaril)  This is an antihistamine that may be used to treat nausea.  It may cause sedation.

If the nausea is severe and/or associated with other symptoms including fever, abdominal pain, jaundice, or headache, one should consult with your healthcare provider immediately.

Important:  Do not stop any medications that you think may be causing the nausea until you have spoken with your healthcare provider.  If you absolutely MUST stop a suspected antiretroviral medication, stop all of your antiretroviral medications at the same time.  Do not stop just the suspected medication or you might lose the effectiveness of the remaining drugs.  This warning does not apply to medications that are not antiretrovirals.


If you would like a PDF version for printing, click HERE.