Opioid-induced Nausea and Vomiting
SOURCE: Raffa RB, Colucci R, Pergolizzi JV. Postgrad Med 2017;129:698-708.
Opioids are highly effective when administered for appropriate indications. Unfortunately, opioid-induced nausea and/or vomiting (OINV) can limit opioid effectiveness. In the immediate postoperative period, OINV can stress wound integrity and prolong hospital stay. In the outpatient setting, some patients are faced with the dilemma of accepting lesser levels of pain control in exchange for less OINV as they consider whether they should decrease their opioid dosing schedule.
A commonly recommended suggestion to reduce OINV is to take the medication with food. Unfortunately, this recommendation rests on historical dogma rather than well-established data. Raffa et al examined studies about OINV to discern whether administration of opioids with food is effective.
The amount and quality of the literature available was quite limited. While some studies reported complete pharmacokinetics and pharmacodynamics of opioids with and without food, the relationship between opioid plasma levels and symptoms often is omitted. Although no consistent relationship between OINV and the fed/fasting state was ascertained definitively, the data reviewed suggested that, if anything, high-calorie, high-fat meals tend to exacerbate OINV. Since much of the trial data found that feeding elevates the maximum plasma opioid dose in some patients, and OINV appears to be related to opioid blood levels, it would make sense that feeding might worsen OINV in susceptible individuals.
Currently, methods to address OINV include antiemetics, reduced opioid dose, and switching between opioids to identify agents with less potential to induce OINV. Taking opioids with food was not demonstrated to reduce OINV.
Opioids are highly effective when administered for appropriate indications. Unfortunately, opioid-induced nausea and/or vomiting (OINV) can limit opioid effectiveness. In the immediate postoperative period, OINV can stress wound integrity and prolong hospital stay. In the outpatient setting, some patients are faced with the dilemma of accepting lesser levels of pain control in exchange for less OINV as they consider whether they should decrease their opioid dosing schedule.
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