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Coping with Nausea

August 2000

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Nausea, or feeling sick to your stomach, is a common but uncomfortable condition. Feelings of nausea can range from slight queasiness to strong urges to throw up. Nausea is not a disease, but rather a symptom of some other problem. It is a common side effect of many drugs used to manage HIV disease. Nausea can also be caused by stress, headaches, spoiled foods, stomach viruses, unpleasant odors, eating or drinking too much or too little, alcohol, street drugs and morning sickness in pregnant women.

Though everyone experiences nausea from time to time, prolonged nausea can interfere with your quality of life. It can make eating, drinking and taking medications difficult, often resulting in not taking your medications as prescribed. For these reasons, it's important that you prevent and control nausea.

This paper focuses on ways to manage nausea. For more information on managing other specific drug side effects, call Project Inform's HIV Health InfoLine at 1-800-822-7422 and request Dealing with Drug Side Effects.


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Causes and Clues

Drug-related nausea is caused by a large number of medications, including anti-HIV drugs and drugs used to treat HIV-related infections. This kind of nausea is generally the most severe during the first few weeks of starting a new drug, before the body has become accustomed to it. For most people, nausea decreases or disappears as the body adjusts to a new treatment. This usually lasts four to six weeks. In other cases, nausea develops when a new combination of drugs is taken at the same time. Some drugs are much more likely than others to cause nausea.

If nausea occurs without a recent change in medication, it is probably not a drug side effect. If it persists or worsens despite your steps to treat it, nausea may be telling you that you have an infection, especially if it's accompanied by other symptoms like fever, diarrhea, abdominal pain, etc. In women, it may be an early sign of pregnancy. Nausea might also be due to or worsened by other lifestyle factors and everyday things, such as diet, yeast, odors, chronic pain, etc.


Getting Control

Preventing and controlling nausea helps ensure that you're able to eat food and take medicine properly. Generally speaking, you should try to control nausea through practical and dietary changes first. These are often effective and generally do not add the risk of other possible side effects.

However, if nausea does not improve with these types of changes, anti-nausea medications may help. In cases of severe drug-related nausea that persists or worsens despite your attempts to curb it, it may be necessary to stop or switch therapy. (See Switching or Stopping Therapy.)

Keeping track of when your nausea occurs and what may be triggering it (specific foods, time of day, surroundings) can give you information you need to prevent or lessen feelings of nausea in the future. You can also share this information with your doctor.

TIP: If you know that nausea tends to occur in the morning -- keep crackers or some other bland food by your bed. Before getting out of bed, prop yourself up with pillows and slowly eat a few crackers. Take time doing this -- about 10 or 15 minutes. It can alleviate feeling nauseous and is a nice way to ease into one's day.


Food Issues

When you're HIV-positive, eating properly is important to maintain weight and get the nutrients you need to stay healthy. However, it can be hard to eat properly when you feel nauseated or you're unable to keep food down. In some cases, even the smell, sight and taste of food can trigger nausea.

Determining which meal times and foods usually trigger nausea can help prevent it in the future. Many beverages and foods can help curb it. Experiment with different foods and beverages to see which work for you. (See Help From Food). Keep plenty of these items on hand in places and times when bouts of nausea may strike (bedroom, kitchen, car, your bag, place of work).

Tip: If nausea tends to occur at breakfast, try to take it easy in the morning and have already prepared foods on hand for when you're hungry. Try breakfast bars, dry toast or re-heat oatmeal that you prepared the night before. Consider not cooking breakfast as seeing and smelling food in the morning can trigger nausea.



Help from Food:

Consider the following tips to help manage nausea. These suggestions have worked for others.
  • Leave dry crackers by your bed. Before getting out of bed in the morning, eat a few and sit in bed for a few minutes.

  • Sip cool, not cold, carbonated drinks, like ginger ale, 7-Up, Sprite or cola.

  • Try some peppermint, chamomile or ginger tea -- they may calm the stomach.

  • Avoid hot, spicy, strong-smelling and greasy foods that might upset your stomach.

  • Eat foods at room temperature or cooler; hot foods may add to nausea.

  • Try using capsules of ginger root powder, available at health food stores. Ginger may reduce symptoms associated with motion sickness, like dizziness, nausea and vomiting.

  • Fresh ginger, lightly cooked or juiced with fruits or vegetables like carrots or apples, is great to add to the diet, and may be as effective as dried ginger.

  • Try the BRAT Diet (Bananas, Rice, Applesauce and Toast).

  • Prevent dehydration during bouts of nausea by drinking small amounts of clear and cool beverages every fifteen minutes or so. Then gradually work your way back up to normal eating by taking small sips of water every several minutes. Increase the intake until you can tolerate a small meal.

  • If you vomit, replace fluids with broth, carbonated beverages, juice, Jell-O or Popsicles.


Practical Issues

When nausea is triggered by something besides medications or other health problems, explore other possible triggers. In addition to particular foods, these might include odors, sights or stress. Keep track of these triggers and try avoiding or lessening them.



Everyday Causes? Try the Following:

  • Avoid odors that bother you, like smoke, perfume or the smell of certain foods.

  • Avoid loud noises and certain sights or images, such as the glare of a television.

  • Get plenty of rest. Try napping during the day. Nausea tends to worsen if you are tired.

  • Get up slowly, and do not lie down right after eating.

  • Drinking liquids with a straw may help you avoid unsettling movement.

  • If cooking odors bother you, open the windows or, if possible, ask someone else to cook meals.

  • Avoid eating in a room that's stuffy, too warm or has cooking odors or smells.

  • Eat meals sitting at a table instead of laying in bed, or on couch or floor.

  • Avoid things that irritate the stomach, like alcohol, aspirin or smoking.

  • Try to reduce your stress through relaxation, exercise, talking with friends, etc.

  • Consider whether your attitude towards or feelings about the medications you take might be contributing to your nausea. After taking large numbers of medications for years, some HIV-positive people feel nauseous at the mere sight of a bottle of pills.

  • Try acupressure or acupuncture.

  • Ask your doctor about anti-nausea medications.


Anti-Nausea Medications

When nausea won't lessen or go away with practical or dietary changes, anti-nausea medications might help. These include Compazine (prochlorperazine), Trilafon (perphenazine) and Torecan (thiethylperazine). Your doctor may prescribe sedatives or hypnotics like Valium (diazepam), Ativan (lorazepam) and Marinol (dronabinol -- which comes from the psychoactive part of marijuana, called THC). Some people report success in managing nausea by using medical marijuana. Finally, Kytril (granisetron) and Zofran (ondansteron) are among the newest anti-nausea drugs. If nausea prevents you from taking pills or holding them down, some anti-nausea medications are available as suppositories, which act quickly and reliably.

Talk to your doctor about the risks and benefits of anti-nausea medications. While they may ease feelings of nausea, they may also have their own side effects. Some are not recommended for use during pregnancy. If you already take medications to treat HIV, consider whether adding another prescription is something you can and want to do. Learn about the possible drug side effects of anti-nausea medications when taken with the therapies you use for HIV disease. Call Project Inform's National HIV Treatment Hotline at 1-800-822-7422 and request the publication, Drug Interactions.


Switching or Stopping Therapy

Sometimes people experiencing serious side effects -- like prolonged nausea -- will switch some of their anti-HIV drugs to improve their quality of life, even though the drugs controlled HIV well. This is one way to deal with side effects linked to a particular drug.

Switching a drug solely because of side effects may also save that drug as a future treatment option. In fact, side effects that you experience with a drug at one time may not occur again if or when you try that drug again in the future.

However, it is dangerous to simply stop taking one drug in your regimen, to take it only periodically or to reduce the dose without talking to your doctor and pharmacist. This can do more harm than good as it may lead to drug resistance, making that drug -- and perhaps others like it -- less useful for you now and in the future.


A Note on Pregnancy and "Morning Sickness"

Nausea or "morning sickness" during pregnancy is normal and usually a problem only during the first three months, called the first trimester. However, pregnant women living with HIV may experience particular difficulty with nausea. This may be because of the combined effect of your body's hormonal changes, using anti-HIV medications and, possibly, HIV disease itself.

Again, nausea in the first trimester is normal. But if it persists into the second trimester (weeks 13-26), or if you cannot hold food down at all or lose weight, consider seeing a doctor at once. It could be a sign of a more serious problem.

Finally, the practical and nutritional tips included in this paper apply to pregnant women as well. Talk to your doctor about the potential dangers of using anti-nausea medications during pregnancy. For more information on pregnancy and HIV, check out Project Inform's publication, HIV and Pregnancy.


Conclusion

Feeling sick to one's stomach can be a disruptive side effect of medications to treat HIV or an uncomfortable symptom of some other problem. Fortunately, there are often simple solutions that exist to lessen nausea. Determining what these solutions are takes a bit of planning and effort, but can be well worth it.




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