Management of Post-Tussive Vomiting

Pharmacological Management

The American Gastroenterological Association recommends ondansetron as the first-line agent for post-tussive vomiting, with a dosing of 8 mg (sublingual) every 4-6 hours during episodes of vomiting, due to its superior efficacy and fewer side effects 1
The American Gastroenterological Association suggests promethazine as a second-line option, with a dosing of 12.5-25 mg by mouth/per rectal every 4-6 hours during episodes, and advises caution due to potential side effects such as CNS depression, anticholinergic effects, and extrapyramidal symptoms 1
The American Gastroenterological Association recommends prochlorperazine as a second-line option, with a dosing of 5-10 mg every 6-8 hours, and 25 mg suppository every 12 hours, and notes contraindications such as history of leukopenia or neutropenia, dementia, glaucoma, or seizure disorder 1

The National Comprehensive Cancer Network recommends sedatives such as alprazolam, lorazepam, and diphenhydramine for anxiety-related coughing paroxysms, with dosing of 0.5-2 mg every 4-6 hours, and advises caution due to potential CNS depression 1 2
The National Comprehensive Cancer Network suggests ensuring adequate hydration and fluid repletion, checking and correcting electrolyte abnormalities, and considering antacid therapy for patients with difficulty distinguishing heartburn from nausea 3 4

The American College of Chest Physicians recommends combination therapy with multiple agents for severe or refractory cases, and considers short-course corticosteroids for severe paroxysmal cough causing post-tussive vomiting 4 5
The American College of Chest Physicians advises treating pertussis-related post-tussive vomiting with macrolide antibiotics, isolating the patient for 5 days, and notes that long-acting β-agonists, antihistamines, corticosteroids, and pertussis Ig are not recommended 5

The National Comprehensive Cancer Network recommends routine around-the-clock administration rather than PRN dosing for persistent vomiting, reassessing treatment efficacy after 24 hours, and adjusting therapy as needed 3

The American College of Chest Physicians warns against failing to identify and treat the underlying cause of cough, using oral medications when the oral route is not feasible, overlooking potential drug interactions or contraindications, and neglecting to monitor for side effects 1 3 5