. Author manuscript; available in PMC: 2020 Jun 23.

Published in final edited form as: Gastroenterol Nurs. 2013 Nov-Dec;36(6):407–413. doi: 10.1097/SGA.0000000000000013

TABLE 3.

Cyclic Vomiting Syndrome Phasic Treatment Options

Phase	Treatment Timing	Treatment Medications
Interepisodic	Prophylactic (daily use)	First Line: TCA Amitriptyline Nortriptyline Desipramine Second-line options: (if TCAs fail) SSRI: citalopram Propranolol Cyproheptadine Imipramine Anticonvulsants: phenobarbital, valproate, carbamazepine Other options: gabapentin, topiramate, levetiracetam, zonisamide Supplements: l-carnitine, coenzyme Q-10
Prodromal and vomiting	Acute (abortive)	Antiemetics Ondansetron Granisetron Gprepitant Benzodiazapine Lorazepam Antimigraine Sumitriptan Frovatriptan Rizatriptan Zolmitiptan Antiemetics Ondansetron Benzodiazapine/sedatives Lorazepam Chlorpromazine Diphenhydramine Analgesics Ketorolac
Recovery		Allow patients to recover without relapse of nausea and vomiting

Phase

Treatment Timing

Treatment Medications

Interepisodic

Prophylactic (daily use)

First Line: TCA

Second-line options: (if TCAs fail)

Prodromal and vomiting

Acute (abortive)

Antiemetics

Benzodiazapine

Antimigraine

Antiemetics

Benzodiazapine/sedatives

Analgesics

Recovery

Allow patients to recover without relapse of nausea and vomiting

Note. SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressants