Treatment options for cyclic vomiting syndrome

Abstract

Since its initial description nearly two centuries ago, treatment of idiopathic cyclic vomiting syndrome (CVS) remains largely empiric because of its obscure pathogenesis and the paucity of controlled therapeutic trials. Despite these challenges, this report reviews open-label trials, retrospective case series, and upcoming consensus guidelines to update the treatment. The treatment approach to a patient with CVS should include consideration of lifestyle changes including avoidance of potential triggers, prophylactic drug therapy to prevent subsequent episodes, abortive and/or supportive care treatment during acute episodes, and support of the family. The mainstays of drug therapy include antimigraine, anti-emetic, and anticonvulsive medications used for prophylactic, abortive, and supportive therapy, with reported efficacies of between 40% and 90%. Prophylactic antimigraine and anticonvulsive agents are used to prevent episodes. Antimigraine triptans are used to abort episodes. Antiemetic agents can reduce the severity of episodes and are best used in conjunction with sedatives.

Cyclic vomiting syndrome in adults

“…TREATMENT Treatment of CVS in adults remains largely empiric because of its elusive pathogenesis and the paucity of controlled therapeutic trials. 69 The overall approach to treating a patient with CVS should include the consideration of lifestyle modifications such as avoidance of triggering factors, prophylactic drug therapy to prevent recurrent episodes, abortive treatment and/or supportive care to ameliorate acute episodes, and psychological support of the patients and family. These recommendations are based on open label trials reported in case series and not generally on more rigorous prospective clinical trials.…”

Breaking the cycle: Cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome

“…The suggested interventions in CVS and migraine can be divided into prophylactic therapy aiming to prevent the occurrence of episodes and treatments aiming to prevent progression of symptoms in the vomiting phase. Preventive treatments consist of antimigraine medications such as propranolol and cyproheptadine (Li et al, 2008;Sudel & Li, 2005), and tricyclic antidepressants such as amitriptyline. Treatments aiming to prevent progression of symptoms in the vomiting phase include benzodiazepine (such as lorzepam) (Fennig and Fenning, 1999) as well as anticonvulsants such as phenobarbitone, carbamazepine, valproate, and topirimate (Fleisher & Matar, 1993).…”

Efficacy of the neurokinin‐1 receptor antagonist aprepitant in children with cyclical vomiting syndrome

“…The management of CVS is aimed at identifying and avoiding individual trigger factors, terminating the acute phase and either preventing subsequent episodes or reducing their occurrence and intensity . Supportive and interventional measures during the acute episode include a dark and quiet environment, intravenous fluids, and anti‐emetic therapies including the 5‐hydroxytryptamine 3 (5‐HT 3 ) receptor antagonist (ondansetron), sedatives such as the benzodiazepine (lorazepam) and chlorpromazine, and in older children anti‐migraine drugs such as 5HT 1B/1D receptor agonists (sumatriptan) .…”