I have been asked on countless occasions by many anxious patients or parents of sick little ones, whether it was appropriate to repeat the dose of a medication after throwing up or vomiting. Below are some general guidelines as well as some medication specific recommendations.
General Steps To Take After Throwing Up
- According to an article in the National Library of Medicine, the dose may be repeated if the vomiting occurs within 15 minutes of taking a pill. It is estimated that 15 minutes is generally not ample time for the medication to be fully absorbed.
- Another instance where repeating the dose may be appropriate is when you actually find the intact pill in the vomit. This obviously is a justification to repeat the dose.
- There is generally no need to take another dose, if one throws up about an hour after taking the medication.
The gray area is when the vomiting occurs between the 15 minute and 1 hour mark. In this case additional factors such as the type of medication or dosage form, as well as the purpose for which it is being taken become important.
Additional Factors To Consider
1. Narrow Therapeutic Index Medications
Narrow therapeutic index (NTI) Drugs as defined by the FDA are drugs for which small differences in dose or blood concentration may lead to serious therapeutic failures or adverse drug reactions.
In other words, slight changes in the concentration of these medications may cause serious adverse effects. These may include but not limited to hospitalization, disability, or even death.
Example of NTI drugs include:
- warfarin
- levothyroxine
- carbamazepine
- digoxin
- lithium carbonate
- phenytoin
- theophylline
For such medications, it is generally not recommended to repeat the dose unless levels of such medications in the blood is demonstrably low or a health professional like a doctor or pharmacist has recommended repeating the dose.
2. When Implications Of A Missed Dose Are Significant
There are some medications for which the consequences or implications of a missed dose are just too significant that it makes more sense to repeat the dose, even at the risk of potentially getting too much medication.
This is true for medications such as regular oral contraceptives, emergency contraceptives like Plan B, and HIV medications.
For such medications, repeating the dose if vomiting occurs within the 15 minute to 1 hour window should be considered.
3. If The Medication Is For An Acute Infection
Consideration should also be given to repeating the dose if vomiting occurs within the 15 minute to 1 hour window for medications used in the treatment of acute infections.
This is even more so, if the duration of the course or therapy is relatively short, such that a missed dose may lead to a failure in therapy.
For example, in clinical trials of Zithromax (azithromycin), the dose was repeated if vomiting occurred within 30 minutes of the first dose.
4. Considerations For Long Acting Opioids
Dosing for long acting opioids like Oxycontin should generally not be repeated if vomiting occurs within the 15 minute to 1 hour window. The potential effects of a doubled dose of such medications are very serious and may include respiratory depression and even death.
A better option will be to forgo taking a second dose and rather utilize a short acting pain reliever should any breakthrough pain occur.
What About Medication Induced Vomiting?
It is not uncommon for some medications to cause nausea and vomiting. Typical examples include chemotherapy medications, some antibiotics like erythromycin and even some very common medications like metformin which tends to have a relatively strong smell depending on the brand.
For such medications, repeating the dose without taking any different precautions may lead to the same result – throwing up again. In such scenarios, the following actions may be taken to minimize the nausea.
- If approved by your pharmacist or doctor, these medications should be taken with some food in the stomach. A little bit of food, like crackers, in the stomach prior to taking the medication, has been shown to reduce the effects of medication induced nausea and vomiting.
- Some foods like fatty or fried foods may be counterproductive and actually aggravate the situation, so they should be avoided.
- Also consider such medications at bedtime. The idea is that one will be able to sleep through the nausea. This will obviously work for medications that are taken only once a day and are not stimulants which can keep you up.
In some scenarios, your doctor may prescribe an anti-nausea medication like Zofran (ondansetron) to be taken prior to the main medication. The goal is usually to reduce the frequency of intensity of vomiting.
This is typically the case for chemotherapy. The good thing about this medication, is that it dissolves quickly in the mouth, making it’s absorption and onset of action very quick. Best practice is to take such medications about 30 minutes prior to taking the main medication.
There is always the option of the medication in question being switched to something completely different when appropriate by your doctor. This may be necessary if you all the options have been tried to no avail.