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Dr. Andrew Rynne
Dr. Andrew Rynne

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Suggest treatment for severe nausea and epigrastric pain

Answered by
Dr. Olsi Taka


Practicing since :2004

Answered : 3650 Questions

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
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

The User accepted the expert's answer

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