How does emetrol work

Nausea and Vomiting: Not Always in Sync

July 18, 2016

Clarence D. Moore, PharmD, BCPS

Pharmacy Times, July 2016 Digestive Health, Volume 82, Issue 7

Nausea and vomiting are symptoms of many different conditions, such as infection, food poisoning, motion sickness, concussion, appendicitis, and various other disease states.

Nausea is defined as the unpleasant, painless urge to vomit. Generally an intended protective mechanism, vomiting is an organized, autonomic response resulting in the forceful ejection of stomach contents through the mouth. Nausea and vomiting are symptoms of many different conditions, such as infection, food poisoning, motion sickness, concussion, appendicitis, and various other disease states. Although nausea and vomiting are frequently discussed together, nausea can occur without vomiting or may precede or follow it.^1-3

BACKGROUND

Individuals often experience nausea accompanied by autonomic symptoms, such as pallor, altered heart rate, diaphoresis, and salivation. ⁴ Vomiting involves a series of events leading to the expulsion of the gastric and, often, the small intestinal contents. The pathophysiologies of nausea and vomiting are poorly understood, as there are many contributing factors to each.^5,6

The brain’s vomiting center, located in the medulla, can induce vomiting when it is stimulated. This center can be activated directly or indirectly following input from the gastrointestinal tract, the cerebral cortex and thalamus, the vestibular region, or the chemoreceptor trigger zone. Because the vomiting center is not protected by the bloodbrain barrier, it is easily permeated by irritants.^5,6

The several neurotransmitters involved in the nausea and vomiting process are not limited to dopamine, histamine, substance P, and serotonin. Although medications are used to target these pathways in the prevention and treatment of nausea or vomiting, many medications may induce nausea or vomiting, as well (Table 1⁷).

TREATMENT OPTIONS

Nausea is a subjective feeling that is sometimes given minimal attention by health care providers who may view it as an annoying side effect and not as a notable issue that requires treatment.⁸ Vomiting can lead to serious consequences, such as aspiration pneumonia. In addition, severe and repetitive vomiting can result in disturbances in the acid-base balance, dehydration, malnutrition, and electrolyte depletion. Continual vomiting may result in the erosion of tooth enamel, thereby increasing tooth sensitivity.^4,8

Although many cases of nausea and vomiting may be self-eliminating, some may warrant the use of medications. For serious cases, prescription medications are often recommended; however, OTC treatment options are often used, as well, with patients consulting pharmacists for recommendations regarding nausea and vomiting. In addition to serving as a medication reference, pharmacists should also be knowledgeable about common conditions that may require referral for further investigation (Online Table 2^6,7).

Table 2. Conditions and Patient Presentations Requiring Referral

Condition

Signs that Require Referral

Appendicitis or bowel obstruction

Severe abdominal pain in the middle or right lower quadrant

Bleeding ulcer or other serious condition, such as cancer

Blood-stained vomit and/or black, tarry stools

Children younger than 1 year who are not urinating, or are listless, lethargic, or crying

This presentation requires referral

Hepatitis

Dark urine and/or yellow discoloration of the skin or eyes, along with cold and flu symptoms

Meningitis

Headache or stiff neck; normal light hurts the eyes

Pregnancy or lactation

If an in-home pregnancy test produces a positive result, refer the patient to a physician for confirmation

Serious head injury (eg, concussion)

History of recent head injury, headache, blurred vision, numbness, or tingling

Acute myocardial infarction, bulimia nervosa, congestive heart failure, gastroparesis, pyelonephritis, migraine headache, pancreatitis, jaundice, urinary tract infection, seizure, and stroke

If suspected, these conditions require referral

OTC Medications

The OTC agents used to treat or prevent nausea and vomiting include various antihistamine products. These agents are typically effective, especially when the nausea or vomiting is due to vestibular causes such as motion sickness.^2,5 Patients receiving these medications should be notified of their potential anticholinergic adverse effects, such as drowsiness, blurred vision, dry mouth, and urinary retention. Because of these effects, these medications should be used with caution in patients with asthma, glaucoma, or enlargement of the prostate gland. In addition, these medications may impair the mental and/or physical abilities required for performing tasks such as driving or operating machinery. The concomitant use of alcohol or other central nervous system depressants may have an additive effect. Age restrictions apply to these medications and should be reviewed prior to administration (Online Table 3^9,10).

Table 3. OTC Antihistamine Antiemetics

Medication (Brand)

Age Restrictions

Indication

Dimenhydrinate (Dramamine)

Do not use in children younger than 2 years

Motion sickness

Diphenhydramine

(Benadryl)

Do not use in children younger than 2 years

Motion sickness (off-label)

Meclizine

(Bonine)

Do not use in children younger than 12 years

Motion sickness

Emetrol—an OTC medication that contains a mixture of fructose, glucose, and phosphoric acid—exerts its antiemetic action by delating gastric emptying time and decreasing smooth muscle contraction. Patients with diabetes should use Emetrol with caution, as more than 5 doses should not be taken within 1 hour.⁹ Bismuth subsalicylate has also been shown to have antiemetic properties. It may cause darkening of the stool or tongue and should not be taken by individuals with an aspirin allergy. Ginger and peppermint are natural remedies that may be used to help decrease stomach contractions, which may cause nausea.¹¹

Pharmacists can play a role in recognizing symptoms of dehydration and suggest that patients consume small amounts of clear liquids or beverages containing electrolytes. Oral rehydration solutions may also be used in mild to moderate cases.^7,12,13

THE PHARMACIST’S ROLE

As frontline health care providers, pharmacists must obtain thorough medical and medication histories to identify underlying causes of nausea and/or vomiting, and treat or refer patients. Pharmacists should be alert to signs of underlying conditions, and pregnancy should always be considered in women of childbearing age. If a condition is deemed self-treatable, pharmacists can be excellent resources for choosing optimal OTC products for symptom management. As medication experts, pharmacists are prepared to recommend optimal therapy based on patient presentation.^6,9,12,13

Dr. Moore is an assistant professor at Howard University College of Pharmacy.

References

Nausea and vomiting. Cleveland Clinic website. my.clevelandclinic.org/health/diseases_conditions/hic_Nausea_and_Vomiting. Accessed May 10, 2016.
Scorza K, Williams A, Phillips JD, Shaw J. Evaluation of nausea and vomiting. Am Fam Physician. 2007;76(1):76-84.
Porter RF, Gyawali CP, Prakash C. Nausea and vomiting. American College of Gastroenterology website. patients.gi.org/topics/nausea-and-vomiting/. Accessed May 10, 2016.
Wilhelm SM, Dehoorne-Smith ML, Kale-Pradhan PB. Prevention of postoperative nausea and vomiting. Ann Pharmacother. 2007;41(1):68-78.
Becker D. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog. 2010;57(4):150-157. doi: 10.2344/0003-3006-57.4.150.
Truter I. Evidence based pharmacy practice: Nausea. S Afr Pharm J. 2008;75(7):12-18.
Bouwer A. Nausea and vomiting: an approach for the pharmacist. S Afr Pharm J. 2011;78(7):28-32.
Smith HS, Smith JM, Smith AR. An overview of nausea/vomiting in palliative medicine. Ann Palliat Med. 2012;1(2):103-114. doi: 10.3978/j.issn.2224-5820.2012.07.06.
Vande Griend JP. The pharmacist’s role in treating nausea and vomiting. Emetrol website. emetrol.com/files/ThePharmacistsRoleinTreatingNauseaandVomiting.pdf. Published September 2009. Accessed May 11, 2016.
Prunty JJ, Prunty LM. An outpatient approach to nausea and vomiting. US Pharmacist. 2013;38(12):24-28.
Vann MR. 4 natural remedies for nausea. Everyday Health website. everydayhealth.com/digestive-health/four-natural-remedies-for-nausea. aspx. Updated June 11, 2015. Accessed May 11, 2016.
Terrie YC. Antiemetics: putting a stop to motion sickness. Pharmacy Times website. pharmacytimes.com/publications/issue/2012/november2012/antiemetics-putting-a-stop-to-motion-sickness. Published November 12, 2012. Accessed May 11, 2016.
Terrie YC. Self-treatment with OTC antiemetics. Pharmacy Times website. pharmacytimes.com/publications/issue/2010/july2010/antiemetics-0710. Published July 13, 2010. Accessed May 11, 2016.

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PublicationsJuly 2016 Digestive Health

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My husband was up and down vomiting for hours last night. He tried Pepto (which is my cure-all) and it did not stay down. Finally I went to the Pharm and they recommended Emetrol. After 1 dose he did not vomit the rest of the night and actually was able to sleep.

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It contains sugar and phosphoric acid-which is used as a cleaning agent. There is no medication to alleviate nausea/vomiting, it is a placebo.

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Overall rating 3.7

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I just wanted to add to these reviews that I took it for morning sickness and after taking it twice or made me throw up.. and my reaction was intense. I don't feel as miserable as I did but I still don't feel great. It is nice to get some relief, though, too

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I've been using emetrol for 20 years whenever I am sick and with nausea. But it has the opposite effect on me. It always makes me vomit. So after I get tired of sitting on the John all day and just want to get it over with, I take 4 or 5 doses of this, vomit everything up, and can finally start feeling better.

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Woke up sick with the stomach flu, puking every 10 minutes. Usually medications of this consistency and flavoring make me sick but this medication did the exact opposite. After struggling to even hold water down I was finally able to put some crackers and broth on my stomach and rehydrate myself. I will definitely be using this any time I am nauseated

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The directions say to take every 15 minutes until feeling better. I did that 3 times, but immediately threw it up, so no help there.

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A pharmacist recommended this to my mom to give to me. I used it for the first time yesterday after I got sick twice in the afternoon and felt nauseous. I get so very anxious about throwing up. I took this medicine and I felt a lot better and calmed down and was able to sleep and I feel so close to normal today. I HIGHLY recommend this.

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I’ve used this medication for 20 years. It works! I’ve used it for eating too much, bad food, flu, anxiety and it always works! It’s my go-to anti-nausea medicine. Don’t believe anyone who says it’s bad for you.

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I've been extremely nauseous for days which, I've been told is from all the changes in my hormones due to peri menopause and birth control pills to regulate my periods. I've tried Dramamine (OTC) and Zofran (prescribed) and of course both made me sleepy. Emetrol works fast for me with no drowsy feeling. I have my life back!

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I have been using this product every since the Dr had me to use it on my son 25yrs ago after getting food poisoning. I keep a bottle in my home. It worked exceptional when I had the norovirus. Highly recommended.

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My daughter has been sick with a rough stomach virus, after 4 days, not vomiting but still nauseous and has diarrhea. She is taking this medicine every 15 minutes and it is helping with the nausea. Any relief from nausea is a gift -- we are grateful for this medication.

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It contains sugar and phosphoric acid-which is used as a cleaning agent. There is no medication to alleviate nausea/vomiting, it is a placebo.

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I have used Emetrol for many years. It is the best med. I have found to get immediate relief of nausea. Always keep in my medicine cabinet.

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I have used Emetrol, brand name & generic, for about 20 years when I get real nausous. Up until last night I hadn't actually vomitted since I was 8 years old; I'd just have to suffer with the nausea but Emetrol has always eased it.

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First of all, look at others' reviews, so the person who wrote that this is a "placebo" is just a troll without any experience using emetrol. I first used this 20 years ago. I've used emetrol in the past year. It works when nothing else has worked. Five stars from each reviewer here. Not only shame on the troll, shame on WebMd for not including it on the list of otc meds for nausea and vomiting. From my experience, this is the best there is. And, yes, it was a trusted pharmacist who first recommended it. The generic or store brand also works just fine. A most excellent anti vomit medication to have in every med cabinet.Read More Read Less

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Severe morning sickness but didn't want to take something that could make me sleepy. One dose and it worked like a charm now this is what I use over prescribed medication!

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Gave it to my 2 year old when she had a fever and stomach bug. It calmed her stomach and she was able to take her fever meds without upsetting her stomach again.

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My daughter caught a stomach virus, and was up during the night vomiting. When I finally got to the pharmacy (Saturday morning) the pharmacist recommended this product. While my daughter is still feeling under the weather, this product has definetely soothed her symptoms and provided her comfort, as well as ceasing the vomiting.

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helped with morning sickness, safe to use, even have used for the kids over the years!!!

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My sister complained of severe nausea(over the weekend)--of course her doctor wasn't available. I checked with her pharmacy, who recommended LEMON flavored Emetrol, and it worked in 2-- 15 minute dosages! I would highly suggest this product!

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How does Enterol work? - Enterol

How Enterol works [1]

Enterol restores the intestinal microbiota, and also directly affects the cause and mechanisms of diarrhea. The strain S. boulardii CNCM I-745 has several unique mechanisms of action at once.

Direct antimicrobial action . Mannose in the wall of saccharomycetes is able to bind pathogenic bacteria, such as salmonella, and its large size (10 times larger than a bacterium) allows it to act as a “trap” for diarrhea pathogens [8. Page 769; 1. p. 2196, figure 6].

Protection of the intestinal wall against pathogens . S. boulardii CNCM I-745 restores the integrity of the intestinal barrier, thereby protecting it from bacterial penetration [2, 1. p. 2196].

Fight against toxins. Saccharomycetes boulardii are able to directly break down the toxins that pathogenic bacteria produce or prevent their effect on the intestines, as is the case with cholera and clostridium, the causative agents of severe diarrhea after taking antibiotics [1. Page 2190-2192].

Elimination of dysbiosis . S. boulardii CNCM I-745 promotes the renewal of the composition of the microflora when its balance is disturbed, for example, after taking antibiotics [1. Cp 2197-2198]. It is known that a “healthy” intestinal microbiota is able to resist the “invasion of strangers” itself [3].

Enzymatic action. Rotavirus diarrhea is caused by malabsorption of sugars that accumulate and draw water into the intestinal lumen [9]. Saccharomycetes CNCM I-745 increase the level of disaccharidases, enzymes that break down simple carbohydrates [4].

Stimulation of local immunity. Saccharomyces increase the level of secretory immunoglobulins A - antibodies that protect against viruses and bacterial toxins [10, pp. 2762, 2764; 1, page 2192 fig. 3B].

Protection of intestinal cells by synthesizing essential nutrients and reducing inflammation [11 p 278; 1 page 2196].

How quickly does Enterol work?

The action on pathogenic bacteria and their toxins begins immediately after the drug enters the intestine, which ensures the reduction of diarrhea already on the 2nd day [5].

Thus, Enterol® 250 is a fast and effective solution for:

prevention of antibiotic-associated and travelers' diarrhea and relapses [6, 1];
treatment acute infectious diarrhea: shortens the duration of symptoms [7/ p146];

recovery intestinal microflora after taking antibiotics [1, p. 2200].

References:

Diversity of Saccharomyces boulardii CNCM I-745 mechanisms of action against intestinal infections (pdf) Sébastien Germain, Renaté Bonier, Adel Hama, Roisin Owens, Dominique Lombardo, Véronique Rigot, Frédéric André, Saccharomyces boulardii CNCM I-745 Restores intestinal Barrier Integrity by Regulation of E-cadherin Recycling, Journal of Crohn's and Colitis , Volume 11, Issue 8, August 2017, Pages 999–1010, https://doi. org /10.1093/ecco-jcc/jjx030
Lawrence Clifford McDonald, Effects of short- and long-course antibiotics on the lower intestinal microbiome as they relate to traveller's diarrhea, Journal of Travel Medicine , Volume 24, Issue suppl_1, April 2017, Pages S35–S38, https://doi.org/10.1093/jtm/taw084
Buts, JP., Bernasconi, P., Van Craynest, MP. et al. Response of Human and Rat Small Intestinal Mucosa to Oral Administration of Saccharomyces boulardii . Pediatr Res 20, 192–196 (1986).
Sahar Feizizadeh, Amin Salehi-Abargouei and Vajihe Akbari. Efficacy and Safety of Saccharomyces boulardii for Acute Diarrhea Pediatrics July 2014, 134 (1) e176-e191; DOI: https://doi.org/10.1542/peds.2013-3950
Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea H. SZAJEWSKA* & J. MRUKOWICZ (pdf)
European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; European Society for Pediatric Infectious Diseases. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. (pdf)
Czerucka D, Piche T, Rampal P. Review article: yeast as probiotics - Saccharomyces boulardii. Aliment Pharmacol Ther. 2007 Sep 15;26(6):767-78. doi: 10.1111/j.1365-2036.2007.03442.x. PMID: 17767461.
Graham D.Y. et al. Pathogenesis of rotavirus-induced diarrhea – Preliminary studies in miniature swine piglet. Digestive Diseases and Sciences. 1984; 29(11): 1028–1035. doi:10.1007/BF01311255.
Qamar A. et al. Qamar A., Aboudola S., Warny M., Michetti P., Pothoulakis C., LaMont J.T., Kelly C.P. 2001. Saccharomyces boulardii stimulates intestinal immunoglobulin A immune response to Clostridium difficile toxin A in mice. society. 2001; 69(4): 2762–2765. doi:10.1128/IAI.69.4.2762.
Martins F.S. et al. Inhibition of tissue inflammation and bacterial translocation as one of the protective mechanisms of Saccharomyces boulardii against Salmonella infection in mice. Microbes and infection. 2013; 15(4): 270–279. doi:10.1016/j.micinf.2012.12.007.

Enterol 079 12.03.21 0166 1 :

remains alive when consumed, which means that already from the moment it enters the intestine, Saccharomycetes boulardii have a positive effect on the course of diarrhea and recovery of the body;
has an optimum growth temperature of around 37 °C, i.e. human body temperature
highly resistant to acids such as gastric juices;
is naturally resistant to the main antibiotics prescribed, which means that they can be taken at the same time as antibiotic treatment.

How quickly does Enterol work in the treatment of antibiotic-associated diarrhea?

The use of antibiotics is sometimes an integral part of therapy. Doctors prescribe antibiotics in the treatment of bacterial tonsillitis, Helicobacter pylori infection, in the postoperative period, to treat complications after suffering atypical viruses (bird flu, coronavirus, etc. ).

An estimated 35% of adults taking antibiotics develop antibiotic-associated diarrhea. The onset of diarrhea (loose, watery stools for > 2 days; early onset during antibiotic treatment or delayed onset 2 to 8 weeks after antibiotic treatment ends). ⁴

The probiotic Saccharomyces boulardii CNCM I-745 has been shown to reduce the incidence of antibiotic-associated diarrhea in adults by 53% when taken concomitantly with antibiotics. And also reduces unwanted manifestations in the first days of admission. ²

How long does it take for Entrol to help treat acute diarrheal infection? Also, 22 studies confirm a reduction in the duration of the acute period by 19.7 hours compared to controls who did not take Saccharomyces boulardii CNCM I-745.

^3.5 The risk of diarrhea with Saccharomyces boulardii CNCM I-745 was reduced by 59% on Day 3 and by 62% on Day 4. ⁵

Course of treatment:

For the prevention of antibiotic-associated diarrhea - the duration of Enterol intake corresponds to the course of antibiotic use;
For the prevention of recurrence of infection caused by Clostridium difficile - the duration of administration of Enterol corresponds to the course of antibiotic use for about 1 month.
To prevent traveler's diarrhea, the course of treatment by day corresponds to the duration of the trip.
For the treatment of irritable bowel syndrome, the drug should be continued until the symptoms disappear.
The drug for the treatment of acute diarrhea lasts 5 days and must be accompanied by rehydration (rich fluids and zinc preparations).

In any case, consultation with a gastroenterologist is mandatory. Also read the instructions.

More MI, and Swidsinski, A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis–a review. Clinical and experimental gastroenterology. 2015; 8: 237.
Szajewska, H et al. 2015. Systemic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea.1
Burande, MA and Burande, AR. Efficacy of Saccharomyces boulardii strain in acute diarrhoea in children: an Indian perspective.
Learn more