Evaluation of opioid induced nausea and vomiting in sickle cell disease

A common side effect of opioids is nausea and vomiting; however, the incidence in hospitalized patients receiving opioids for acute pain is unknown. We performed a retrospective study in adult patients with sickle cell disease admitted for an acute pain crisis during a six-month period to evaluate the incidence of nausea and vomiting and characterize the prescribing of antiemetics. Eligibility included normal hepatic and renal function. Thirty-four subjects with a total of 97 admissions were evaluated. As expected, opioids were prescribed during all admissions. Fifty percent of the subjects experienced nausea or vomiting during the study period and these same patients accounted for the majority of the admissions, 17 subjects with 71 admissions (Group I). Nausea was reported in 18 (25%) of these admissions and vomiting was reported in 24 (34%) of these admissions. The most common antiemetics prescribed were: prochlorperazine, metoclopramide, and promethazine and antiemetics were ordered during 22 (23%) separate admissions for all subjects included in the study. The clinical benefit of these medications is limited due to uneven documentation. In conclusion, many of our patients experienced nausea or vomiting with antiemetics infrequently prescribed on an as needed basis. This suggests a need for better approaches to manage nausea and vomiting in patients receiving opioids.