Nausea, retching, and/or vomiting may be associated with the use of a medication. Nausea and emesis are common adverse drug effects, often occurring shortly after starting a medication and frequently associated with abdominal pain, headaches, and diarrhea. In some instances, drug-induced nausea and emesis resolves with continued use of the offending agent over a few weeks. In other cases, symptoms persist and medication changes should be made. Some patients find that symptoms are improved by taking the medication on an empty stomach, with food, prior to bedtime, or at a lower dose. If symptoms persist and a medication is necessary at its prescribed dose, supportive therapy with antiemetics can frequently provide relief.
There are several mechanisms by which drugs may cause nausea. Some agents result in gastrointestinal mucosal irritation or ulceration (eg, NSAIDs, doxycycline). Other agents activate the chemoreceptor trigger zone of the area postrema via dopaminergic receptors. The specific neural pathways by which nausea is triggered may help guide its management.
Many medications are associated with nausea and vomiting (see Drug Reaction Data below).
Drug-induced nausea or vomiting
Alerts and Notices
Synopsis

Codes
ICD10CM:
R11.0 – Nausea
R11.10 – Vomiting, unspecified
R11.2 – Nausea with vomiting, unspecified
SNOMEDCT:
419219000 – Drug-induced nausea and vomiting
R11.0 – Nausea
R11.10 – Vomiting, unspecified
R11.2 – Nausea with vomiting, unspecified
SNOMEDCT:
419219000 – Drug-induced nausea and vomiting
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Acute gastroenteritis
- Pregnancy
- Pancreatitis (acute and chronic)
- Cholecystitis / biliary colic
- Migraine headache / abdominal migraine
- Peptic ulcer disease
- Gastroparesis
- Gastric outlet obstruction
- Eosinophilic gastroenteritis
- Gastroesophageal reflux disease
- Crohn disease
- Small or large bowel obstruction or stricture
- Gastrointestinal malignancy (eg, gastric and small bowel cancer)
- Lymphoma
- Chronic idiopathic intestinal pseudo-obstruction
- Appendicitis
- Cyclic vomiting syndrome – marijuana use is strongly associated
- Brain tumors
- Vestibular neuritis
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:01/10/2018
Last Updated:06/14/2018
Last Updated:06/14/2018