Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
192 Doctors Online

By proceeding, I accept the Terms and Conditions

Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

HCM Blog Instant Access to Doctors
HCM BlogQuestions Answered
HCM Blog Satisfaction

Suggest treatment for severe nausea and epigrastric pain

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

default
Posted on Sat, 3 Sep 2016 in Digestion and Bowels
Question: I have severe Gastroparesis with global dysmotility throughout the small and large intestines and am having a very difficult time controlling the nausea and pain (epigrastric that wraps around to the back and colon spasms. I am on IV Zofran (4mg every 4 hrs prn), Tigan q6, IV Benadryl 25 mg with no more than 6 doses in a day, Ativan solution( 2mg every 4 hours prn). I have had sensitivity to phenergan, compazine, scopolamine, and a few others I can't recall. I am on TPN and have been for 8 years. Can you suggest anything to control the nausea and spasms. Oh, I am on baclofen and tinzanidine for the spasm. I have a neurostimulator to control the colon spasms. It takes the spasms down by 30%. I am also on Remeron 15mg tid and have failed on other antidepressants. I just want the nausea and pain better controlled. I forgot I wear a 50mcg fentanyl patch changed every 72 hours and have 4mg oral dilaudid that I can take every 4 hours. I am a complicated case. On paper I look fabulous but functionally we can't figure out the correct combination of meds to control the symptoms. I have started using essential oils and will begin acupuncture on Wednesday. Oh one more thing, I have a mutation that increases my chances of forming blood clots. I had a pulmonary embolus in March and will be on Lovenox daily for he rest of my life. Any help or suggestions would be greatly appreciated. XXXXXXX XXXX
doctor
Answered by Dr. Olsi Taka 25 hours later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

I have to say that yours is indeed a difficult case, with many drug interactions and failures to consider.

Regarding nausea I would say you already take some of the most potent medication against it out there. The only medication I could add which could be tried would be Domperidone, I wonder if you have already tried it. I would also reconsider the necessity of fentanyl and dilaudid as they are opioids and both have the potential for causing nausea themselves.

As for spasms, I must say I am not that crazy about the use of baclofen and tizanidine. They are antispasmodic medication true, but are generally used for spasms of skeletal muscle not smooth muscle like in the stomach and intestine. Alternatives which are used for intestinal spasms are dicyclomine, hyoscyamine, mebeverine (fewer side effects than the first 2) or the old papaverine. I am listing several and not only one of them in case you have already tried some, but of course they are not taken all together.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions
Drug/Medication ,   ,   ,   ,  
Treatment/Therapy

Recent questions on  Compazine

doctor1 MD

nausea and dizziness
I have had persistent nausea, constipation, sour stomach and dizziness for 2 years now. I take 30mg of Compazine per day, I...

doctor1 MD

so im a 24 year old,female with history of anorexia and bulimia. Three years ago,anorexia became so severe from inability to swallow normally and...

doctor1 MD

After 13 dilatation and/or needle knife proceedures, i still have a severe esophageal stricture ( 2mm opening) two years post esophageal ca...

doctor1 MD

I have brought my daughter to the er for a migraine. They gave her compazine and benedryl. Cat scan and blood work are clear. Her blood pressure...

doctor1 MD

HI, My wife is having severe nausea issues. She has been complaining about it right after her vaginal delivery 13 months ago (third child), she...

doctor1 MD

I would like to know drug interactions of the use of Xanax, tramadol/acetaminophen, and Compazine in a man of 85 years of age. Patient was very out...

doctor1 MD

Hello doc. I ve aken 4 tabs of Nordette but wasn t able to take the 2nd dosage after 12 hrs because my body couldnt handle it. I vomited a lot but...