OTC antiemetic medications: Relief for nausea and vomiting

In this article:

• Types of OTC antiemetic
• How do antiemetic drugs work?
• Antiemetic side effects
• Precautions and interactions when taking OTC antiemetics
• Summary

In this article

• Types of OTC antiemetic
• How do antiemetic drugs work?
• Antiemetic side effects
• Precautions and interactions when taking OTC antiemetics
• Summary

Nausea and vomiting can be miserable and often unexpected symptoms that can ruin anyone’s day. Many people turn to over-the-counter (OTC) antiemetics, hoping for fast relief. Symptoms of nausea and vomiting can be caused by various factors such as stomach flu, motion sickness, pregnancy, medication side effects, and certain medical conditions. 

Antiemetics are anti-nausea drugs. The root word “emesis” is the medical term for vomiting. These medications work by targeting pathways in your brain and blocking signals that make you feel nauseous or vomit. Some antiemetics are available over the counter, while some are exclusively prescription drugs. Besides prescription and OTC antiemetics, some people find that natural remedies such as ginger, peppermint, and cannabidiol (CBD) are helpful.

Wondering about the best OTC antiemetic for yourself or someone you care for? Keep reading to learn more about OTC antiemetics, natural remedies, and prescription medications to determine which may work best.

Types of OTC antiemetic

There are two main types of OTC antiemetic medications: antihistamines like Dramamine (dimenhydrinate) and bismuth preparations like Pepto-Bismol (bismuth subsalicylate). Even though you can get these medicines without a prescription, it’s a good idea to talk to a healthcare professional like a physician or pharmacist to determine which one is best for you.

Antihistamines

When you think about antihistamines, allergy medications may come to mind. However, antihistamines can help with other ailments besides allergies. Antihistamines work by blocking the effects of histamine, a chemical released by your body’s immune system. Histamine plays a role in allergy symptoms, such as sneezing, but it also has other effects. Certain antihistamines work as antiemetics by blocking histamine from binding to receptors in the area of the brain that cause unpleasant symptoms. 

These medications can help with motion sickness, vertigo, postoperative nausea, and morning sickness. Antiemetics may also reduce radiation-associated or chemotherapy-induced nausea resulting from cancer treatment.

Other than Dramamine, some common OTC antihistamines used as antiemetics include Bonine (meclizine), Benadryl (diphenhydramine), and Unisom (doxylamine).

Dramamine (dimenhydrinate)

Dramamine is approved by the Food and Drug Administration for relieving and preventing motion sickness. Healthcare professionals may recommend it for treating or preventing nausea and vomiting in other situations as well. This medication is particularly useful for preventing nausea if you take it ahead of time, in anticipation of a known trigger, such as before car travel or radiation treatment.

For adults and children 12 years and older, the typical dosing of Dramamine is 1 to 2 tablets every four to six hours as needed. To prevent motion sickness, the first dose should be taken 30 minutes to an hour before starting the bothersome activity. 

Dramamine is safe for pregnant women to take and may also be used for postoperative nausea after surgery. Dramamine is also safe for children ages 2 and older. Be sure to follow the dosing instructions on the label for your child’s age. If your child is younger than 2, check with their doctor before giving Dramamine or any other anti-nausea medication.

Some common side effects of Dramamine include drowsiness, blurred vision, dry nose and throat, and constipation. Because of these side effects, Dramamine should be used with caution in older adults. Note that other medications can interact with Dramamine, so check with a healthcare provider or pharmacist to make sure it’s safe for you to take.

Bonine (meclizine)

Meclizine is a generic antihistamine used for nausea and vomiting. It’s available with and without a prescription. Bonine is a brand-name version available over the counter as a tablet or a chewable tablet and is approved for treating and preventing symptoms of nausea, vomiting, and dizziness related to motion sickness. 

Healthcare providers also recommend meclizine for vertigo, which is dizziness resulting from imbalances within your inner ear. Providers may also recommend meclizine for managing nausea and vomiting during pregnancy. 

Bonine is safe for use in children 12 years old and older, with typical dosing of 12.5–25 mg every 6 to 8 hours as needed for nausea. The total dosage should not exceed 100 mg per day. Note that this medication should not be used by people with severe kidney disease. Common side effects of Bonine include dry mouth, drowsiness, and blurred vision. Like Dramamine, Bonine carries risks of drug interactions. Before taking Bonine, discuss all medications you currently take with a trusted healthcare professional to help prevent harmful interactions.

Benadryl (diphenhydramine)

Diphenhydramine is commonly used for relieving allergies, but this medication can be used as an antiemetic as well. 

Healthcare providers may recommend diphenhydramine to manage nausea and vomiting associated with motion sickness and vertigo. Also, Benadryl is generally considered safe for use during pregnancy. 

Benadryl can be used in adults and children ages 6 and older. Consult a pediatrician before giving diphenhydramine to a younger child. 

The typical dosage of diphenhydramine is 25–50 mg every four to six hours as needed. To prevent motion sickness, take it 30 to 60 minutes before you anticipate motion. The maximum dosage totals 300 mg per day. 

Common side effects of Benadryl include sleepiness, dry mouth, fatigue, and blurred vision. Similar to other antihistamines, Benadryl can interact with other medications. Benadryl is not usually recommended for older adults due to the risk of drowsiness and falling.

Unisom (doxylamine)

Doxylamine is another antihistamine medication used to treat nausea and vomiting in pregnant women alongside pyridoxine (vitamin B6). In fact, doxylamine is a first-line recommended treatment for nausea and vomiting of pregnancy. 

Unisom should not be given to children for nausea and vomiting.

For nausea and vomiting associated with pregnancy, the usual dosage of doxylamine is 12.5 or 25 mg once daily at bedtime. If your symptoms are not controlled at this dose, your doctor may recommend a higher dosage. Common side effects of doxylamine include headache, drowsiness, and constipation.

Bismuth subsalicylate 

Another OTC antiemetic that can be used for nausea and vomiting is bismuth subsalicylate. This ingredient is found in several brand-name and generic medications, including:

• Pepto-Bismol tablet, chewable tablet, liquid suspension, and capsules. 
• Kaopectate tablet and liquid suspension

Bismuth subsalicylate is FDA-approved for treating nausea and vomiting. It can also ease an upset stomach, diarrhea, heartburn, and indigestion. In some cases, healthcare providers may recommend it as part of a combination treatment for H. Pylori, a type of stomach infection. 

Note that bismuth subsalicylate is not safe for children younger than 12 years old. Bismuth subsalicylate may induce Reye’s syndrome in children, a serious illness causing brain and liver swelling. Likewise, bismuth subsalicylate should not be used in pregnant women.

The Pepto-Bismol brand also markets a product designed especially for kids, but note that this medication contains an antacid as the active ingredient (calcium carbonate), not bismuth.

The typical dosage of Pepto Bismol for adults and children 12 years and older is 1–2 doses every 30–60 minutes as needed for up to two days. The total dose should not exceed 16 tablets/capsules or 240 milliliters in one day. 

Possible side effects of Pepto-Bismol include headache, constipation, and bloating. This medication should not be used if you are allergic to aspirin or if you have an ulcer, bleeding problem, or bloody or black stool. A healthcare provider can advise on which option is best for you.

Natural remedies

Natural remedies remain an important option to consider for managing nausea and vomiting. While the supporting evidence is mixed, some potentially effective options for easing nausea include: 

• Vitamin B6: Pyridoxine (vitamin B6) has demonstrated effectiveness in reducing nausea and morning sickness in pregnant women. This vitamin supplement can be taken alone but is usually recommended in combination with doxylamine.
• Ginger: Some studies have shown that ginger improves nausea.
• Peppermint: Peppermint extracts, oils, and teas may also act as a natural antiemetic. 

How do antiemetic drugs work?

Different antiemetics work in different ways. Antihistamines block the effects of histamine, preventing it from reaching the part of your brain that triggers nausea and vomiting. For bismuth-containing medications, the exact mechanism remains unclear, but bismuth is thought to soothe irritation, reduce inflammation, and stop painful movements of the stomach lining. Since these types of medications work differently, they can be taken together if necessary.

Antiemetic side effects

Most OTC antiemetics are well-tolerated and safe if taken according to the labeled instructions. Like other medications, though, antiemetics can cause side effects.

Common side effects of antihistamines like Dramamine and Bonine are drowsiness or sleepiness, dry mouth, and blurred vision. 

Bismuth products like Pepto Bismol can cause bleeding, darkening of your tongue or stools, headaches, and constipation. Bismuth subsalicylate is not recommended for use in children under 12 years old due to the risk of Reye’s syndrome.

Precautions and interactions when taking OTC antiemetics

OTC medications can be helpful for nausea and vomiting, but it is important to seek medical attention if your symptoms are severe. The same advice is recommended if your symptoms last longer than two days. Dehydration, bloody vomit, intense abdominal pain, a recent head injury, fever, and other concerning symptoms are all reasons to get professional help.

If you’re experiencing nausea and vomiting during pregnancy, speak with your OB-GYN about how best to manage it. Note that if you are experiencing severe vomiting while pregnant, this should not be treated with OTC antiemetics, as severe vomiting could be a symptom of hyperemesis gravidarum. This is a serious complication of pregnancy that often requires hospitalization to manage uncontrollable vomiting and prevent weight loss and dehydration. 

It is always better to be cautious and consult a healthcare professional if unsure of what to do or if you feel concerned about your symptoms.

Before taking an OTC antiemetic, let a healthcare provider know all supplements and OTC and prescription medications you are taking to prevent harmful interactions. While not a complete list, some common examples of drug interactions are listed below: 

• Antihistamines may interact with antidepressants, certain antibiotic medications like erythromycin, some fungal medications, blood pressure medications, muscle relaxants, and other medications that cause sedation or drowsiness.
• Bismuth subsalicylate may interact with medications such as valproic acid, acetazolamide, steroid medications, and methotrexate, among others.
• Natural remedies can have interactions, too. For example, ginger supplements may increase the risk of bleeding if taken with blood thinners like warfarin.

Summary

Nausea and vomiting can be managed with various medications, both prescription and OTC. It is important to stay hydrated and seek medical attention if symptoms are severe or persistent. Popular OTC options include Dramamine and Pepto-Bismol, but some people should use them with caution. Prescription antiemetic medications may be necessary for more severe cases.