How often do pain meds cause vomitting?

Published

So I have a patient that is on Vicodin and fentantyl patch,he has been throwing up lately..I was wonderig if it is common for a patient on vicodin or fentanyl to vomitt also my patient has a cancer and has a hiccups but is not on chemo drugs right now,he just got of hospita couple days ago,he do experience hiccups (pancreatic cancer).Do you think that excessive hiccups could have caused the vommiting or is it because they probably gave him chemo couple days ago and it is still in the system or is it the pain meds responsible for that?,patient also is just started Lantus and Nexium as well as new blood pressure med (ACE-inhibitor).He is also on other meds like Plavix,aspirin,diuretic,Ambien as needed and Reglan as well as Bystolic and two oral diabetic meds (his metformin was reduced lately ito half dose) and he used to take glipizide but it was changed to Juvania (wrong spelling?) Also the patient is administering Lantus to himself in the arm he does have a pancreatic cancer,is it safe to teach him to administer insulin the subcutanously in the part of lower stomach?

Up Vote Up Vote ×

Just my "gut" saying usually if a medicine is going to cause nausea it does right from the start. Has he been on Vicodin and the patch for a while? He sounds very sick!!!! Could be anything causing the nausea!!!!!

Up Vote Up Vote ×
Specializes in Oncology/Haemetology/HIV.

It could be the chemo or the pain meds or the hiccups. Or a combination of any/all of them.

But as a note, pancreatic cancer frequently causes nausea and vomitting completely on its own. That is one of the big miserys of it, and a hallmark of that disorder. Or mets may be causing obstruction.

Up Vote Up Vote ×
Just my "gut" saying usually if a medicine is going to cause nausea it does right from the start. Has he been on Vicodin and the patch for a while? He sounds very sick!!!! Could be anything causing the nausea!!!!!

I think he has been for a while on Vicodin but I think fentanyl is new.And yes he was recently diagnosed with pancreatic cancer,the sad part is is that he never drank or smoke but he does suffer from the diabetes type two which is a well known risk factor for developing a pancreatic cancer in future,of course alcohol and smoking is probably number one.Plus pancreatic cancer is usually found in people above 65 years (he is above 70 y)Also he does have a hypertension as well coronary artery disease (stent) and like a mentioned diabetes.

Up Vote Up Vote ×
It could be the chemo or the pain meds or the hiccups. Or a combination of any/all of them.

But as a note, pancreatic cancer frequently causes nausea and vomitting completely on its own. That is one of the big miserys of it, and a hallmark of that disorder. Or mets may be causing obstruction.

mets,?:confused:

Up Vote Up Vote ×
Specializes in Surgical/MedSurg/Oncology/Hospice.

Mets=metastases, which could cause an obstruction which could lead to N/V. The patient's problems could be from any number of things, be it the disease processes or the treatment/meds. The oncologist could order imaging studies or other tests if antiemetics are not effective.

Up Vote Up Vote ×
Mets=metastases, which could cause an obstruction which could lead to N/V. The patient's problems could be from any number of things, be it the disease processes or the treatment/meds. The oncologist could order imaging studies or other tests if antiemetics are not effective.

He is on reglan only-reglan is for his hiccups and vomitting,he can take up to 4 tabs (10 mg per tab).

Up Vote Up Vote ×
Specializes in NICU, Vascular, Oncology, Telemetry.

You might also ask about getting some additional antiemetics on board. The N&V is most likely caused by the cancer itself plus the chemo (as a previous poster stated). There's a whole orificenal of things the patient could/should be getting to prevent all this N&V....sounds like he needs it.

Up Vote Up Vote ×
Specializes in Critical Care.

I'd definitely ask the physician to consider ruling out ileus/bowel obstruction. Went to a RRT call for a patient with a similar diagnosis (had a hx of n/v over the past few days and was now hypotensive). The hypotension was actually secondary to sepsis from ASPIRATING vomitus (nice). One of the first things I did when I got up there was drop an NG and 2 + liters (think Pepsi bottle) was evacuated from his stomach :eek:.

Up Vote Up Vote ×

As with most Pancreatic pts sounds like he's got multiple issues.If he continues with the hiccups (hiccoughs) and the reglan is not working Ive seen them use Baclofen (? possible recommendation to the MD?)

As others have said he needs an antiemetic asap... may need to cycle through a few before you get the right mix that work. Nausea and vomiting is caused by a few different pathways (ie chemical : from the cancer and the drugs, mechanical from the cancer etc...)

Check and see if your area and his providers have a palliative care team (which is different then the hospice team) but they are an outstanding addition to the care team for these patients... Unfortunately this patients presentation is typical for pancreatic patients and more often then not it does not get better than this without aggressive symptom management.

Up Vote Up Vote ×
Specializes in M/S, Travel Nursing, Pulmonary.

Hmmm, I've seen IV pain meds make people sick but don't recall pills doing it. Not saying it doesn't happen, I just can't recall an incident right now.

I've worked a lot of M/S, we get people who are very dependent on pain relief. When they get to the hospital, they are almost immediately put on IV Dilaudid. I give 2mg Q2 to a number of patients. Sometimes, I get so comfortable administering it, I forget these people have a unique tolerance. You can push it, diluted, very quickly and they don't notice anything. So, when I get that rare pt. who is not used to getting it all the time, I have to remember to dilute and push SLOW. You know right away when you've given it to someone too fast, they look and feel like someone hit them over the head with a brick.

Up Vote Up Vote ×

narcotics can and do cause n/v, but it's unusual to see these symptoms last more than a week.

i suspect it's either r/t the type of cancer he has, or even something as simple as constipation, which pain meds will cause this as well.

he should be routinely taking senna daily.

pancreatic ca is nasty and aggressive.

i'm pretty confident that it has metastacized, causing irritation of either his phrenic nerve or diaphragm.

reglan will not be enough.

you usually need to give a combo of meds for hiccups.

we use haldol, thorazine, ativan, baclofen, reglan, etc...

and it's very common that our pts will take any 2-4 of these meds.

dexa has worked well too.

i would ask the doc for either haldol or thorazine, since both are good for n/v, hiccups and anxiety.

and if he's not on a regimen to prevent constipation, get him on one immediately.

folks have no idea how much more pain and misery, being constipated causes...

especially with pts who have a gi cancer.

prayers for comfort and faith, for this poor soul.

leslie

Up Vote Up Vote ×
+ Add a Comment