Nausea and Vomiting in Heart Failure

Loss of appetite and nausea are potential symptoms that people with heart failure (HF) experience. It can relate to a feeling of being full and having a bloated abdomen, despite not having eaten.

This may be caused by an accumulation of fluid around the digestive tract and slower stomach emptying in people with HF. In fact, one study found that bloating affects 25% of people with HF. Furthermore, 17% and 32% of people with HF experience nausea and vomiting respectively.^1-2

The following article will outline treatments for nausea and vomiting. Before starting any of these treatments, it is very important that you speak to your doctor, as nausea and vomiting are sometimes indicative of worsening HF.

Treatments

The available drugs used to treat nausea are categorized depending on whether they treat nausea that presents acutely, such as during an infection, or more chronically, as in the case of people with HF. While there are both over-the-counter (non-prescription) and prescription options, it is best to ask your doctor before trying any of the non-prescription remedies.

Lifestyle options

Some people find that implementing lifestyle techniques can help control nausea. Lifestyle approaches can include:²

• Avoiding eating right before laying down
• Avoiding food that delays stomach emptying, such as fatty food
• Minimizing foods with strong odors
• Alternative therapies, such as acupuncture or music therapy
• Opening up windows for fresh air while eating

Non-prescription drugs

Gravol/Dramamine is the most commonly available non-prescription option for nausea. It contains the active ingredient dimenhydrinate. Because this drug can cause significant drowsiness, it is generally recommended to use sparingly.²

Gravol/Dramamine Ginger contains ginger to treat nausea. While this would not cause drowsiness, note that there are many interactions with ginger and heart medications, so always be sure to ask a pharmacist prior to trialing this. For example, ginger can increase the risk of bleeding if taken with some blood thinners such as warfarin.³

Prescription drugs

There are many prescription drugs available to treat nausea - these can be used on a regular basis or as needed. Examples include:²

• Drugs that help speed stomach emptying (i.e., domperidone, metoclopramide) - these drugs increase contractions and movements in the stomach and bowel, which can help reduce nausea. However, some of these drugs can increase the risk of arrhythmias, so your doctor will prescribe the one that is safest based on your medical history.
• Drugs that work on the brain (i.e., ondansetron) - these kinds of drugs work on the brain to help reduce the feeling of nausea. Note that some of these drugs also should be used in caution in people with HF due to their effect on the heart.

Managing chronic nausea in heart failure often requires a multi-faceted approach. Some people may also benefit from having other experts in their care such as a dietician or cognitive-behavioral therapist.

Do you experience nausea as a result of HF? What treatments have been effective for you? Share your experiences below!