Nausea and vomiting

Most HIV drugs list nausea as a possible side effect.

In practice, this is now less common. If it does occur it is generally mild and short term.

Nausea (feeling sick) and vomiting (being sick) can sometimes happen when starting ART. This usually improves over the first week or two as your body gets used to the meds.

Using an anti-emetic (anti-sickness) pill regularly is often enough. If one anti-emetic does not work, it is worth trying others. Some work by emptying your stomach more quickly and others by stopping the signals that tell your brain that you feel sick.

If the nausea does not improve, your doctor should look for another cause. If it is related to an HIV drug, then you might need to change to another medication.

If you are taking abacavir (now rarely used) contact your clinic straight away to rule out a hypersensitivity reaction.

Medications used for nausea

Domperidone (Motilium): 10-20 mg every 4-8 hours. Suppositories 30-60 mg every 4-8 hours are a good alternative to swallowing pills when you are feeling sick.

Metoclopramide (Maxolon): usually 10mg, 3-times a day. There are slow-release versions, which can be used twice a day, including Maxolon SR and Gastrobin Continuous; however, they should not be used in anyone under 20 years old. Be aware of dystonic reactions (twitching movements) at higher doses.

Prochlorperazine (Stemetil): usually 5-10 mg, 2-3 times daily. A special preparation is available called Buccastem, 1 or 2 tablets are placed between the upper lip and gum and left to dissolve; not having to swallow more pills is useful when you are feeling sick.

Haloperidol: 1.5 mg daily or twice daily where nausea is severe. Particularly useful as can be taken at night to avoid early morning nausea.

Sometimes these medications have side effects themselves that you should ask your doctor about.

Where other medications and lifestyle changes have failed and nausea continues, then medications that are normally reserved for people receiving very strong chemotherapy may be prescribed.

These include granisetron, ondansetron and tropisetron and they are highly effective.

Other suggestions

If changing your medication is not an option and the nausea is continuous, then any of the following suggestions can help.

• Eat smaller meals and snack more frequently rather than eating just a few larger meals
• Try to eat more bland foods and avoid foods that are spicy, greasy or strong smelling
• Leave some dry crackers by your bed and eat one or two of them before getting up in the morning
• Ginger is very helpful and can be used as capsules, ginger root powder or fresh root ginger peeled and steeped in hot water
• If cooking smells bother you then open the windows while cooking and keep the room well ventilated
• Microwave meals prepare food quickly and with minimum smells, so you can eat a meal as soon as you feel hungry. Getting someone else to prepare your meals can help, if this is possible
• Don’t eat in a room that is stuffy or that has lingering cooking smells
• Eat meals at a table rather than lying down and don’t lie down immediately after eating
• Try not to drink with your meal or straight after: it is better to wait an hour and then sip the drink slowly
• Try eating cold rather than hot food or let hot food cool well before you eat it
• Peppermint is also useful and can be taken in tea, sweets or chewing gum
• Acupressure and acupuncture can also be very helpful, anti-nausea acupressure bands are available from most chemists
• Try to avoid things that irritate the stomach such as alcohol, aspirin and smoking

Last updated: 1 March 2023.