Drug Induced Nausea – The Clinical Thought Process
Stomach problems can often be a common issue in the elderly and drug induced nausea can sometimes be a challenge to identify due to polypharmacy. If you look under adverse effects of medications, nausea is a side effect for virtually every medication. Here’s a medication list to review for drug induced nausea.
Aspirin 81 mg daily
Metformin 1000 mg twice daily
Cymbalta (duloxetine) 30 mg daily
Prilosec (omeprazole) 20 mg daily
Tylenol 1,000 mg three times daily
Percocet 5/325 mg four times daily as needed
Aricept (donepezil)10 mg daily
Zofran (ondansetron) 4 mg three times daily as needed
Now focusing on the medications, the first critical question you should ask to identify possible causes of drug induced nausea is: When did it start? This is always one of the first questions I think of when assessing a case. Timing is so critical, not everytime, but most of the time. Other questions might be are there other symptoms associated like loose stools, heartburn, other GI problems? Another consideration would be what dose of each medication are they on? (i.e. is it a high dose for that med) Do they have a diagnosis that might cause their nausea? Is diet a contributing factor? Do they have bad times of the day? or is it more constant? Just looking at the meds, from my experience, metformin and Aricept are the most probable to cause the issue. So identifying if either of theses has been started OR increased…sometimes increased gets forgotten about. Percocet is also another possibility (need to watch out for Tylenol limit as well). I’d like to know how much/if this patient is taking that and try to correlate that with the nausea as well. – Just a few tips on trying to identify drug induced nausea!
Here’s a case of drug induced nausea from the past.
Also remember to check out the 30 medication mistakes that all healthcare professionals should know. Great resource for students and those who teach students!