Managing Nausea and Vomiting

As mentioned in the previous section, most HIV-positive people who experience nausea or vomiting usually do so after starting a new HIV drug regimen. In most cases, these side effects lessen or go away completely after the first few days or weeks of treatment. As a result, most doctors encourage their patients to "stick it out." However, this does not mean that you should simply grin and bear it. Even though nausea and vomiting are common side effects of ARV therapy, they should not be considered a normal part of living with HIV—there are ways to manage these side effects to help you maintain your quality of life and to get the most out of your treatment.

When in doubt, talk to your doctor! If nausea is seriously affecting your quality of life, including your ability to eat, or your vomiting continues for more than just a few days, you should call your doctor. There are steps you can take to manage both of these side effects:

Switch treatments: One option may be to replace the offending drug with a similar drug that may not cause nausea or vomiting. Unfortunately, it is often difficult to determine which drug, when used in a combination of medicines, is the most likely culprit. Because many of the HIV drugs can cause nausea or vomiting, it can also be difficult to predict whether nausea or vomiting will actually improve (or get worse) upon switching to another drug. What's more, switching to another drug might not be possible for patients who have a limited number of drugs to choose from (i.e. they may be resistant to other drugs). As a result, switching treatments is often reserved for people who experience profound nausea or vomiting.

Prescription treatments for nausea and vomiting: A class of drugs called antiemetics—medicines that prevent or control nausea and vomiting—are available by prescription. These drugs work by blocking receptors in the brain's vomiting center. In patients being treated for cancer using high doses of chemotherapy, antiemetics are effective more than 75% of the time. In turn, they offer a great deal of potential for HIV-positive people experiencing nausea or diarrhea due to their HIV drug treatment. Unfortunately, antiemetics are not without side effects of their own: they have a tendency to make people feel drowsy or feel mildly sedated.

Some of the most commonly prescribed antiemetics include Zofran (ondansetron), Kytril (granisetron), Anzemet (dolasetron) and Decadron (dexamethasone). Not all drugs are equally effective for all patients, and antiemetics sometimes work best when given in various combinations. Another option is dronabinol and Marinol (THC), a drug that contains a synthetic version of the active ingredient in marijuana. In order for any of these drugs to be effective, it's best if they are taken 30 to 45 minutes before taking any of the ARV drugs. It's also important to note that some of the antiemetics, particularly Reglan (metoclopramide), can be dangerous if it is taken at the same time as some of the protease inhibitors, including Norvir (ritonavir) and Kaletra.

Marijuana: Marijuana itself has also been reported, both anecdotally (word of mouth) and in small studies, to be effective for nausea and appetite loss (anorexia). Aside from being an illegal substance, it is important to note that smoking any substance is dangerous to the lungs and may aggravate existing lung problems, particularly asthma or bronchitis. Eating marijuana—by baking it in food (pot brownies, etc.)—is considered by some to be a safer way to experience the medicinal effects of this drug. Though the federal government still considers marijuana an illegal substance for any use, several states have legalized marijuana for medicinal use.

Healthy tips: Very often, nausea and vomiting can be managed without having to switch therapies or by having to add additional medicines to an already complicated regimen. Consider some of the following:

• Eat small meals frequently instead of two or three large ones. Large amounts of food in the stomach may make feelings of nausea worse.
• Cut a lemon and smell the slices to lessen nausea.
• Ginger has long been used in folk-medicine to dispell nausea. Many people find ginger ale or ginger tea to be helpful.
• Bland foods are easier to digest. Stick to foods low in fat but high in starches and carbohydrates to fuel the body's energy needs.
• Relax before meals and chew slowly.
• Breathe deeply and slowly when you first feel nauseated. Also, avoid odors such as smoke, perfume, and cooking odors.
• The use of Sea Bands (placed between the two tendons on the inside of the forearm about two inches up from the wrist) has antiemetic effects. These are available at many pharmacies and stores that specialize in travel products.

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