How often do pain meds cause vomitting?

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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?

Specializes in Surgical ICU.

the same thing happened at my hospital last week. the man was on the floor for over a week like that till he finally bottomed out and ended up in my unit, the ICU. 2-3 L came out in minutes :eek:.

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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

He does have a senna prescribed as needed.He claims he does not have constipation. I was thinking the same thing that Reglan isnt enough.

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Specializes in PACU, OR.
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.

Probably any and all of the above, however Fentanyl definitely lists nausea/vomiting under its side effects.

Additional warnings include "impaired liver or kidney function", (and with pancreatic cancer and chronic alcoholism, there has to be liver involvement), and also cautions against use in patients with obstructive bowel disorders

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Hiccups is just the diaphragm having spasms. I don't think vicodin or fantanyl are causing that. As far as the SQ, I don't see a problem with it, if the pt has ascites then maybe the arms or the thighs might be a better place. N/V, oh my goodness, sleeping on the wrong side of the bed could cause that, so to speak. In anycase, I would inform the physician and let him/her get the ball rolling, labs, kub, what ever they might order and get to the bottom of this. Diagnosing is always a good thing to do, in order to give the right advice and to make recommendations to the doc, but inform the MD. That would be my call.

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Specializes in Mostly geri :).

I can only speak from personal experience-I've taken percocet and Vicodin when I've had dental surgery-I've never felt nauseaous or hungry when under their effect. PS-last wisdom tooth is breaking skin-it's almost over lol!

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Specializes in Med/Surg.

When I took vicodin for an ear infection, before I became a nurse, it made me so nauseas. If the pain hadn't been so bad I wouldn't have taken them. I literally felt so rotten I laid on the couch with a pail to throwup in because i couldn't get off the couch. Then to make it even worse I felt so rotten I wasn't eating or drinking anything with them and ended up with a case of heartburn so bad I made my mom take me to the ER because I thought I was having a MI.

My first thought is that there are probably multiple things going on. I'd definitely start by asking the doctor for some imaging studies to rule out complication/progression from the disease. Then like another poster said, thorazine is very effective for hiccups and I've actually had quite a bit of luck with tessalon pearls.

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Thanks so much for all your replies.I wrote down the meds you guys suggested and will present it the patient's doctor

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Specializes in Mostly geri :).
When I took vicodin for an ear infection, before I became a nurse, it made me so nauseas. If the pain hadn't been so bad I wouldn't have taken them. I literally felt so rotten I laid on the couch with a pail to throwup in because i couldn't get off the couch. Then to make it even worse I felt so rotten I wasn't eating or drinking anything with them and ended up with a case of heartburn so bad I made my mom take me to the ER because I thought I was having a MI.

My first thought is that there are probably multiple things going on. I'd definitely start by asking the doctor for some imaging studies to rule out complication/progression from the disease. Then like another poster said, thorazine is very effective for hiccups and I've actually had quite a bit of luck with tessalon pearls.

I'm sorry that happened, I'm amazed I didn't get nasty side effects, if that's the norm-did you take em with food?

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Thanks so much for all your replies.I wrote down the meds you guys suggested and will present it the patient's doctor

it probably wouldn't hurt you to read up on the meds you'll be suggesting...

especially about their labeled and unlabeled uses.

you'll be better prepared with your pt and the doctor.

leslie

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Specializes in OB/GYN, Peds, School Nurse, DD.
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

Ugh. Vicodin makes me barf every time. And forget Fentanyl. I had a Fentanyl epidural with my last baby. I swear, I vomited that kid out. In 8 hours of labor I vomited 16 times. :uhoh3: And the anesthesiologist refused to acknowlege that the Fentanyl was causing it. I finally just ripped the thing out and went natural.

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Specializes in Hospice.

If he is getting chemo is he getting his anti emetic before chemo? Pain meds can cause vomitting but it could be related to his dx as well. I would see about getting compazine or haldol(is used off label for cancer nausea) on board to see if they can be helpful. Haldol works really well with our our cancer pts.

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Specializes in pulm/cardiology pcu, surgical onc.
Thanks so much for all your replies.I wrote down the meds you guys suggested and will present it the patient's doctor

What does your supervisor think? Shouldn't you be getting extra support since you're a new grad? I would run it by him/her also to keep them informed and they might also have some advice too. I wouldn't base your patients care and what could be wrong with him by what anonymous people advise on an online forum.

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