A young mother called one morning to tell me her five-year-old son was vomiting and asked what she could do. I suggested the standard of rest, sips of Pedialyte, or Gatorade (not the sugar-free versions), and time.
Later that day, when the vomiting hadn’t stopped, the mother called her pediatrician and was told to take the child to urgent care for some Ondansetron (trade name, Zofran), a powerful drug used to stop severe nausea and vomiting. The wisdom of motherhood stepped in and they decided to visit Urgent Care the next day if things weren’t better.
The nurse and the pediatrician reassured the mother that the drug is safe. That’s not what’s written in the drug maker’s own extensive list of possible side effects. Current literature about the drug states, “Zofran is not for preventing nausea or vomiting that is caused by factors other than cancer treatment or surgery.” And, “nausea or vomiting that is new or worse” is on the list of contraindications. That means using Zofran to stop vomiting actually could make things worse, but not to worry because experts in the pediatrician’s office disagreed with the published information, or perhaps the drug company salesperson failed to mention it.
At the time of the first call, the child had been ill for a total of about five hours. A simple stomach bug or food poisoning commonly resolves in 24 to 48 hours, not five. It is fully understandable to want instant relief. Being real, though, it usually doesn’t work that way. When the vomiting is relentless, and caused by something far more serious, such as cancer, a drug such as Zofran will be ordered to block the symptoms. It is understood, too, that merely blocking the symptom of vomiting will not cure the underlying problem.
Vomiting is what a body often does to rid itself of a harmful substance, food poisoning, toxic substances, and flu bugs. It always has been a bad idea to block a natural body action, yet the first inclination is to do something, right now. It’s akin to our collective mania overusing drugs to block a fever or stifle a cough, similar common reactions that demonstrate how our body works to build its own defense systems. A symptom informs the body that something unexpected is happening, which doesn’t always mean we should do something to put a stop to it, especially by using drugs that pose health risks themselves.
It isn’t prudent for a pharmacist to openly refute the advice from the doctor’s office, but I tried to assure the mom to relax and be prepared to wait out the problem, offering comfort and sips of Pedialyte.
A few days later we heard that all symptoms had resolved by supper time the first evening.
There is a place for drugs such as Zofran, especially in those who are seriously nauseous. Without a powerful reason, it remains questionable that a child who has been sick for five hours needs a potentially toxic drug to stop vomiting.
As predicted, time, rest, and electrolytes were all that were needed. The little guy was ready to roll the next day.
Larry Frieders is a pharmacist in Aurora who had a book published, The Undruggist: Book One, A Tale of Modern Apothecary and Wellness. He can be reached at thecompounder.com/ask-larry or www.facebook.com/thecompounder.