Dramamine All Day Less Drowsy; Antivert; Bonine

Aluminum/magnesium/simethicone combos

Maalox Advanced, Mylanta Maximum Strength

Pepcid, Pepcid AC, Pepcid Complete, Zantac 360

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GI Disorders

Medications

Generic name	Brand name	Indication(s)	Dose frequency	Route	Side effects	Boxed warnings	Contraindications	Clinical pearls
Dimenhydrinate	Dramamine	Motion sickness, vertigo	PRN	Oral	Anticholinergic effects (dry mouth, blurred vision, drowsiness, confusion, dizziness, tremors, constipation); possible QTc prolongation		Caution: angle-closure glaucoma, BPH; avoid in elderly/asthma; caution with CNS depressants/operating machinery	For motion sickness, take 30-60 min before travel and continue during travel
Diphenhydramine	Benadryl	Motion sickness, vertigo	PRN	Oral (OTC), IV (Rx)	Anticholinergic effects; sedation; QTc prolongation		Caution: angle-closure glaucoma, BPH; avoid in elderly/asthma; caution with CNS depressants/operating machinery	—
Meclizine	Dramamine All Day Less Drowsy; Antivert; Bonine	Motion sickness, vertigo	1 h before travel, then q12-24 h PRN	Oral	Anticholinergic effects; less drowsy than other AHs		Caution: angle-closure glaucoma, BPH; avoid machinery use; avoid in elderly/asthma; caution with CNS depressants	Longer acting
Doxylamine		Nausea/vomiting of pregnancy (with pyridoxine)	PRN	Oral	Anticholinergic effects; drowsiness		Caution in elderly; used in pregnancy only with pyridoxine as noted	Used off-label for NVP especially with pyridoxine (B6)
Hydroxyzine	Vistaril; Atarax	Motion sickness, vertigo	PRN	Oral	Anticholinergic effects; sedation; QTc prolongation		Avoid in elderly; caution in asthma; caution with other CNS depressants	—
Scopolamine	Transderm Scop	Motion sickness	every 72 h	Transdermal patch	Anticholinergic effects; lowest QT risk among AHs		Caution in glaucoma; remove patch before MRI	Apply 4 h before travel; replace every 72 h
Trimethobenzamide	Tigan	Nausea and vomiting	TID-QID	Oral, IM	Dizziness, anticholinergic-like effects			—
Chlorpromazine	Thorazine	Simple NV, PONV, breakthrough CINV	PRN	Oral, IM, IV	QTc prolongation, tachycardia; anticholinergic effects; EPS; NMS (rare)	Increased mortality in elderly patients with dementia-related psychosis		Orthostatic hypotension
Prochlorperazine	Compazine	Simple NV, PONV, breakthrough CINV	PRN	Oral, IM, IV, rectal	Anticholinergic effects; EPS; QTc prolongation; NMS (rare)	Increased mortality in elderly patients with dementia-related psychosis		Orthostatic hypotension
Promethazine	Phenergan; Promethegan	Simple NV, PONV, breakthrough CINV	PRN	Oral, IM, IV, rectal	Sedation; anticholinergic effects; severe tissue injury with IV extravasation	Do not use in children <2 years (respiratory depression); severe tissue injury with injectable formulation (avoid intra-arterial/subcutaneous; deep IM preferred)	Age <2 years	Deep IM preferred if oral unavailable
Haloperidol		Breakthrough CINV, palliative care		—	QTc prolongation, tachycardia; anticholinergic effects; EPS; NMS (rare)	—		—
Droperidol		Rescue antiemetic for PONV		—	QTc prolongation, tachycardia; anticholinergic effects; EPS; NMS risk with other dopamine antagonists	Requires 12-lead EKG prior to administration and 2–3 hours monitoring after (QT prolongation)		Rescue antiemetic for PONV
Metoclopramide	Reglan	Simple NV (esp. gastroparesis), refractory pregnancy-associated NV, PONV	dose adjust in renal impairment	—	EPS, CNS depression, diarrhea, QT prolongation, galactorrhea, gynecomastia	Tardive dyskinesia		Increases LES tone; aids gastric emptying; accelerates small bowel transit (prokinetic)
Olanzapine	Zyprexa	CINV (with aprepitant/fosaprepitant & 5-HT3-RA); adjunct PONV		—	Sedation, orthostatic hypotension, increased QTc; neuroleptic malignant syndrome (rare)	Increased mortality in dementia-related psychosis		Blocks dopamine, adrenergic, histamine, and 5-HT3 receptors
Granisetron	Sancuso; Sustol	Simple NV, pregnancy-associated NV, acute phase CINV, PONV	max 1 mg	PO, IV, subcutaneous, patch	Asthenia (fatigue, weakness), constipation, headache, QTc prolongation (dose-related; higher risk with IV); serotonin syndrome risk with serotonergic agents		Do not use with apomorphine (severe hypotension/LOC)	Patch applied 24–48 h before chemo; may leave up to 7 days. SQ Sustol is extended release effective for delayed CINV
Ondansetron	Zofran; Zuplenz film	Simple NV, pregnancy-associated NV, acute phase CINV, PONV	IV should not exceed 16 mg	PO, IV	Asthenia (minimal sedation), constipation, headache, QTc prolongation (dose-dependent); serotonin syndrome risk		Do not use with apomorphine (severe hypotension/LOC)	IV doses should not exceed 16 mg due to QTc
Palonosetron	Aloxi	Acute and delayed CINV; PONV		IV	Asthenia, constipation, headache; less effect on QTc; serotonin syndrome risk		class apomorphine interaction 5-HT3 Ras	Longer half-life (~40 h), effective for delayed CINV; PO only available in combo with netupitant
Dolasetron	Anzemet	CINV; PONV		PO	Asthenia, headache, constipation; serotonin syndrome risk		class apomorphine interaction	Only PO available
Aprepitant / Fosaprepitant	Emend	CINV; PONV (off-label)	PO dosing with redosing on subsequent days for high emetic risk chemo/ single IV dosing	PO (aprepitant); IV (fosaprepitant)	Dizziness, fatigue, weakness; constipation; hiccups		CYP3A4 interactions; reduce dexamethasone dose by 50% when combined; CYP2C9 induction reduces hormonal contraceptive exposure during and 28 days after	Shorter half-life (~9 h) requires redosing on subsequent days for high emetic risk chemotherapy
Netupitant/Fosnetupitant + Palonosetron	Akynzeo	CINV; PONV (off-label)		PO; IV	Dizziness, fatigue, constipation; hiccups		Moderate CYP3A4 inhibitor—may require reduced dexamethasone dose	Covers both acute and delayed CINV
Rolapitant	Varubi	CINV	q 2 weeks	PO	Dizziness, fatigue, weakness; constipation; hiccups		CYP2D6 inhibitor—raises concentrations of some chemo; IV formulation withdrawn in US due to potential anaphylaxis (soybean allergy risk)	Long half-life allows single dosing per cycle
Dronabinol	Marinol	Breakthrough CINV; appetite stimulation	As directed (solution vs capsule forms differ)	PO	Somnolence, euphoria, increased appetite, orthostatic hypotension; cannabinoid hyperemesis syndrome		Caution with history of substance abuse or psychiatric disorders	Solution contains 50% alcohol; higher bioavailability than capsules; must be refrigerated; solution is C-II, capsule C-III
Nabilone	Cesamet	Breakthrough CINV	As directed	PO	Somnolence, euphoria, increased appetite, orthostatic hypotension; cannabinoid hyperemesis syndrome		Caution with psychiatric disorders/substance abuse	Controlled substance C-II
Calcium carbonate	Tums	Episodic heartburn	PRN; often multiple times/day per product labeling	PO	Constipation; belching/flatulence		Severe renal dysfunction (caution)	Preferred in pregnancy; liquids act faster than tablets
Magnesium hydroxide	Milk of Magnesia	Episodic heartburn	PRN	PO	Diarrhea		Severe renal dysfunction (avoid if CrCl <30 mL/min)	Often combined with aluminum salts to balance GI effects
Aluminum hydroxide	Maalox, Mylanta (in combos)	Episodic heartburn	PRN	PO	Constipation; hypophosphatemia (chronic use)		Severe renal dysfunction (avoid if CrCl <30 mL/min)	Binds many drugs—separate by 2–4 hours
Sodium bicarbonate	Alka-Seltzer (various)	Episodic heartburn	PRN	PO	Belching/flatulence; edema (sodium load)		Heart failure, renal failure, pregnancy, cirrhosis (worsening edema)	Risk of milk-alkali syndrome at high intake
Aluminum/magnesium/simethicone combos	Maalox Advanced, Mylanta Maximum Strength	Episodic heartburn	PRN (per product)	PO	Constipation or diarrhea (balanced in combos)		Severe renal dysfunction	Liquids act faster; dosing often 4–6x/day per label
Bismuth subsalicylate (as antacid/adjunct)	Pepto-Bismol	Heartburn/indigestion; part of H. pylori regimens	PRN or QID in H. pylori regimens	PO	Black stool/tongue; increased bleeding risk	Reye’s syndrome risk in <18 yrs with viral illness	Salicylate allergy; children/adolescents with viral illness	Use bismuth subcitrate if salicylate allergy in H. pylori therapy
Famotidine	Pepcid, Pepcid AC, Pepcid Complete, Zantac 360	Mild–moderate episodic heartburn; stress ulcer prophylaxis (ICU)	daily–BID (OTC); ≤20 mg BID for SUP	PO/IV	Headache; CNS effects in elderly; constipation/diarrhea		Adjust dose in renal impairment (CrCl <60 mL/min)	Tachyphylaxis after ~2 weeks scheduled use—best PRN
Cimetidine	Tagamet	Mild–moderate episodic heartburn	QID - BID	PO	CNS effects; antiandrogenic effects (gynecomastia, impotence)		Major CYP interactions (1A2, 2C19, 2D6, 3A4 substrates)	Avoid with theophylline, warfarin, phenytoin, etc.
Nizatidine	Axid	Mild–moderate episodic heartburn	daily–BID	PO	CNS effects; GI effects		Adjust dose if CrCl <50 mL/min
Ranitidine (new non-NDMA formulations)	Zantac	Mild–moderate episodic heartburn	BID	PO	CNS effects; GI effects		Adjust dose if CrCl <50 mL/min	Recently returned to market per lecture
Omeprazole	Prilosec	GERD (≥2 days/week), erosive esophagitis, H. pylori regimens	BID (self-care limited to 14 days)	PO	Headache; abdominal pain; diarrhea/constipation; rebound acid			Take 30–60 min before meal; CYP2C19 interactions incl. clopidogrel
Esomeprazole	Nexium	GERD, erosive esophagitis, H. pylori regimens	BID	PO/IV	Similar to class; rare AIN; lupus			CYP2C19 inhibitor like omeprazole (clopidogrel interaction)
Lansoprazole	Prevacid (incl. ODT)	GERD, erosive esophagitis		PO	GI; headache			ODT available; sprinkle options
Pantoprazole	Protonix	GERD; stress ulcer prophylaxis/bleeding regimens	daily–BID; high-dose in UGIB	PO/IV	GI; headache; IV thrombophlebitis/skin reactions (rare)			EC tablet can be taken without regard to meals
Dexlansoprazole	Dexilant	GERD	daily	PO	GI; headache			Dual delayed-release (peaks ~1–2h and 4–5h)
Rabeprazole	AcipHex	GERD	daily–BID	PO	GI; headache			EC tablet can be taken without regard to meals
Omeprazole/sodium bicarbonate	Zegerid	GERD; rapid-release PPI option	daily–BID	PO	Sodium load effects (belching/edema)		HF, renal impairment, cirrhosis (sodium load)	Not enteric-coated; faster onset vs standard PPI
Sucralfate	Carafate	PUD mucosal protection; (not recommended for SUP)	QID before meals	PO	Constipation; hypophosphatemia; bezoars		Caution in renal failure (aluminum accumulation)	Separate other meds by ≥2 h before or 4 h after (binding)
Misoprostol	Cytotec	Prevention of NSAID-induced ulcers	QID with food	PO	Diarrhea; abdominal cramping; flatulence; hypophosphatemia	Abortifacient; uterine rupture	Pregnancy; avoid for prophylaxis in women of childbearing potential unless high risk	High AE burden; PPIs preferred for most
Bismuth subcitrate		H. pylori (BQT when salicylate allergy)	QID	PO	Black stool/tongue; bleeding risk		Caution in renal failure, bleeding disorders	Use instead of subsalicylate if salicylate allergy
Optimized Bismuth Quadruple Therapy (PPI + metronidazole + tetracycline + bismuth)		H. pylori eradication (1st line; penicillin allergy compatible)	PPI BID; metronidazole 500 mg TID–QID; tetracycline 500 mg QID; bismuth 300 mg QID	PO	GI upset; metallic taste; photosensitivity; black stool/tongue		Tetracycline in pregnancy/<8 yrs; salicylate allergy if subsalicylate used; alcohol with metronidazole	Duration 14 days; take PPI 30–60 min before meals; adherence critical
Rifabutin Triple Therapy (omeprazole + amoxicillin + rifabutin)	Talicia (combo product)	H. pylori eradication (first-line option)	Omeprazole 40 mg TID; amoxicillin 1 g TID; rifabutin 50 mg TID (Talicia 4 caps TID)	PO	Rash; leukopenia; urine discoloration; GI upset		Amoxicillin in penicillin allergy; rifabutin interactions (CYP3A4)	High pill burden; check interactions
Vonoprazan Dual Therapy (vonoprazan + amoxicillin)	Voquenza DualPak	H. pylori eradication	Vonoprazan 20 mg BID + amoxicillin 1 g TID x14 days	PO	Class GI effects; amoxicillin diarrhea/allergy		Penicillin allergy	PCAB more potent acid suppression; food-independent
Vonoprazan Triple Therapy (vonoprazan + amoxicillin + clarithromycin)	Voquenza TriplePak	H. pylori eradication (if clarithromycin susceptible)	Vonoprazan 20 mg BID + amox 1 g BID + clarithro 500 mg BID x14 days	PO	GI; clarithromycin QT prolongation, metallic taste		Penicillin allergy; strong CYP3A4 interactions (clarithro)	Clarithro only if susceptibility known
Concomitant therapy (PPI + clarithro + amox + metronidazole)		H. pylori eradication (non-bismuth quadruple)	PPI BID; clarithro 500 mg BID; amox 1 g BID; metronidazole 250–500 mg BID x10–14 days	PO	GI; metallic taste; QT risk (clarithro)		Alcohol with metronidazole; macrolide interactions	Avoid clarithro unless susceptibility known
Levofloxacin triple (PPI + levofloxacin + amox or metronidazole)		H. pylori eradication (alternative/salvage)	PPI BID; levo 500 mg daily; amox 1 g BID or metronidazole 500 mg BID x14 days	PO	QT prolongation; tendon rupture; photosensitivity	Tendon rupture; peripheral neuropathy; CNS effects; MG exacerbation	History of tendon disorders; myasthenia gravis	Reserve for susceptibility-guided use
Clarithromycin triple (PPI + clarithro + amox/metronidazole)		H. pylori eradication (alternative; only if susceptible)	PPI BID; clarithro 500 mg BID; amox 1 g BID or metronidazole 500 mg BID x14 days	PO	Metallic taste; diarrhea; QT prolongation		Strong CYP3A4 interactions; QT prolongation risks	Avoid empirically due to resistance
Amoxicillin		H. pylori regimens	BID–TID	PO	Diarrhea; hypersensitivity		Penicillin allergy	Low resistance; consider allergy testing if needed
Metronidazole	Flagyl	H. pylori regimens	BID–QID	PO	Metallic taste; nausea; alcohol intolerance		Concomitant alcohol (disulfiram-like)	Avoid alcohol during therapy
Tetracycline		H. pylori BQT	QID	PO	Photosensitivity; esophagitis		Pregnancy; children <8 years (tooth discoloration)	Drink plenty of fluids; separate from cationic products
Rifabutin		H. pylori (first-line option in triple therapy)	TID (in combo)	PO	Rash; leukopenia; orange urine/secretions; diarrhea		Strong CYP3A4 interactions	Previously salvage; now first-line option per lecture
Levofloxacin	Levaquin	H. pylori alternative/salvage	daily (in combo)	PO	QT prolongation; tendon rupture; ↑LFTs; photosensitivity	Tendinopathy/rupture; peripheral neuropathy; CNS effects; MG exacerbation	History of tendon disorder; myasthenia gravis	Reserve for susceptibility-guided use
Clarithromycin	Biaxin	H. pylori regimens (if susceptible)	BID (in combo)	PO	Metallic taste; diarrhea; QT prolongation		Strong CYP3A4 interactions; QT prolongation risk	Use only with susceptibility data
Naproxen/esomeprazole	Vimovo	Pain/inflammation with GI protection		PO	NSAID-related GI/CV risks; PPI GI effects	Serious CV and GI risks (class for NSAIDs)	NSAID contraindications (ulcer, bleeding risk, etc.)	Combination for patients needing NSAID + PPI
Ibuprofen/famotidine	Duexis	Pain/inflammation with ulcer risk reduction		PO	NSAID + H2RA effects	Serious CV and GI risks (NSAIDs)	NSAID contraindications; renal impairment	Convenience combo; famotidine ≤20 mg BID in SUP
Diclofenac/misoprostol	Arthrotec	Pain/inflammation with ulcer prevention		PO	NSAID AEs; misoprostol diarrhea/cramping	NSAID CV/GI risks; misoprostol pregnancy warning	Pregnancy; NSAID contraindications	Use contraception if of childbearing potential
Aspirin/omeprazole	Yosprala	Cardioprotection with GI protection		PO	Aspirin bleeding risk; PPI AEs	Aspirin-related bleeding risk warnings	Aspirin allergy; active bleeding	Fixed-dose combo for secondary CV prevention
Omeprazole/Esomeprazole/Pantoprazole (low-dose for SUP)	Various	Stress ulcer prophylaxis in ICU with risk factors	daily	PO/IV (depending on agent)	Class PPI effects; potential infection risk			Discontinue when risk factors resolve or ICU discharge
Famotidine (SUP)	Pepcid	Stress ulcer prophylaxis in ICU with risk factors	BID	PO/IV	CNS effects in elderly/renal impairment		Dose adjust in renal impairment	Enteral or IV; discontinue when risk resolves
Vonoprazan (PCAB)	Voquenza	GERD; H. pylori therapy (as part of Dual/TriplePak)		PO	Class-like GI AEs			Potent, food-independent acid suppression; higher eradication vs some PPI triples

Created by: CaristW

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