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Nausea & vomiting
Nausea is a word for the feeling of wanting to vomit or be sick. It is a common symptom, which most people with HIV experience at some time.
Nausea and vomiting can have many different causes, commonly stomach problems such as diarrhoea (see NAM Factsheet 4: Diarrhoea), acute infections, pregnancy, travel sickness or emotional problems such as anxiety. They are also common side-effects of antiretroviral drugs used to treat HIV.
Drug side-effects
Many anti-HIV drugs are associated with nausea. However, it is most commonly reported as a side-effect of AZT Retrovir, d4T Sustiva, 3TC Epivir, and abacavir Ziagen from the NRTI class. Protease inhibitors which commonly cause nausea include indinavir Crixivan and ritonavir Norivr and those containing a small dose of ritonavir (Norvir) to boost their effectiveness. Some of the drugs used to treat infections commonly seen in people with HIV also cause nausea, including, cidofovir Vistide, foscarnet Foscavir, ganciclovir Cytovene, intravenous pentamidine Pentam, co-trimoxazole Septrim and clarithronycin Klaricid.
If nausea is accompanied by other symptoms, the underlying cause needs to be investigated and treated. If it is due to drug side-effects then the dose and frequency may need to be altered or the drug discontinued. For example, the nausea and vomiting which can accompany use of the protease inhibitor ritonavir may be eased by splitting the usual daily dose, i.e. changing from 600mg or 7.5ml twice daily to 300mg or 3.75ml four times daily. This would result in less extreme variations in the concentration of ritonavir in the blood stream and body tissues. Don’t alter the dosing of your treatments without discussing it with your doctor first.
Some drugs, e.g. AZT, can be taken with food in order to limit nausea. Talk to your HIV pharmacist or doctor about this to clarify which foods can be eaten with your medication, and which to avoid, or see Nutrition in NAM’s information series for people with HIV.
Anti-nausea medication
Anti-nausea medication (sometimes called anti-emetics), taken either as tablets or injections, can be prescribed by your doctor to help manage symptoms. This can be particularly important when starting a new treatment, such as anti-HIV combination therapy, which is associated with a high risk of nausea and vomiting during the first few weeks. Adequate anti-nausea medication can help you to adjust to your new regimen and make this initial period easier.
Many different drugs are used to treat nausea and/or vomiting. These include metoclopramide, prochlorperazine, perphenazine, trifluoperazine, chlorpromazine, domperidone, granisetron, ondansetron, tropisetron and nabilone.
Practical advice
For some people, having to swallow large tablets or large numbers of tablets can itself bring on bouts of nausea. If you think this might be a problem for you, consider how it might influence your choice of anti-HIV therapy, for example by asking to see the different drugs available and being clear about the number of doses required.
Whatever the cause, do not feel obliged to "grin and bear it" – nausea and vomiting can prevent you from getting enough food and nutrients and from sticking with your chosen treatment regimen. As well as asking your doctor about anti-emetic medication, the following practical tips may be helpful and can be discussed with an HIV dietitian:
- Eat small, frequent meals throughout the day rather than two or three large meals.
- Don’t eat liquid and solid food at the same meal. Space them at least one hour apart.
- Avoid eating greasy, fatty, fried or spicy food. Instead choose bland tasting food.
- Try dry food such as toast, crackers, cereal, and fruit and vegetables that are bland or soft.
- Salty food such as crackers, pretzels and popcorn can help reduce nausea. Carry a packet with you when you leave the house.
- Don’t lie flat for at least an hour after you eat.
- Eat food cold or at room temperature – hot food can worsen nausea.
- Herbal tea (e.g. peppermint or chamomile) or root ginger can help settle upset stomachs.