Cyclical vomiting syndrome

Avoidance of triggers, attaining adequate sleep (sleep in a dark room) and measures for reducing stress and anxiety are part of treatment for both prevention and prophylaxis of cyclical vomiting syndrome.

Dose as per specialist.

Dose as per specialist and BNFc.

Dose as per specialist.

Prescribing Notes:

Diagnostic criteria for cyclical vomiting syndrome include:
- Two or more periods/cycles of intense, unremitting nausea and paroxysmal vomiting, which lasts for hours- days within a 6-month period.
- At least four episodes of vomiting per hour with a median of 6 per hour at the peak.
- Stereotypical episodes in each patient.
- Episodes separated by weeks to months.
- Symptoms not attributable to any other condition.
Treatment aims for early recognition and prompt initiation of therapy at onset of prodrome symptoms (if present) or of typical attack – see references for acute management:
- European Journal of Pediatrics – Managing cyclic vomiting syndrome in children: beyond the guidelines.
- North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition: Consensus Statement on the Diagnosis and Management of Cyclic Vomiting Syndrome.
- Frontiers in Neurology: Cyclic Vomiting Syndrome in Children.
If symptoms fail to abort, child should attend hospital for IV access and baseline investigations. Prescribe IV fluids and medication based on individual patient plan / expert advice – see references. These may include IV fluids (standard IV fluids for CVS should be a 10% dextrose 0.45 saline mix), IV ondansetron, IV lorazepam +/- appropriate pain relief.

History Notes

15/01/2024

East Region Formulary content agreed.

Dose as per specialist.

Propranolol should be avoided in children with a history of asthma or bronchospasm.
Prescribers should be aware of recent increases in propranolol overdoses and consider patients risk factors before prescribing.

Dose as per specialist.

Prescribing Notes:

Avoidance of triggers, adequate sleep and measures for reducing stress and anxiety are important factors in supporting prophylaxis of cyclical vomiting syndrome.
All females of childbearing potential should be advised of potential of foetal malformations with migraine prophylactic medications. Ensure that risks during pregnancy are explained and the importance of using adequate contraception.
Propranolol should be avoided in children with a history of asthma or bronchospasm.
Prescribers should be aware of the risk of propranolol in overdose, which can be potentially toxic and lead to seizures and death.
Prescribers should be aware of recent increases in propranolol overdoses and consider patients risk factors before prescribing.

History Notes

15/01/2024

East Region Formulary content agreed.