Materiały źródłowe

• #1 Cyclic vomiting syndrome: diagnostic approach and current management s | CEG

  https://www.dovepress.com/cyclic-vomiting-syndrome-diagnostic-approach-and-current-management-st-peer-reviewed-fulltext-article-CEG

  Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of nausea and vomiting lasting for 15 days followed by asymptomatic periods. […] Current management strategies include trigger avoidance, abortive and prophylactic medication therapies, and supportive care. The goal of therapy for the remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine medications show an overall reduction or remission of CVS symptoms in more than 70% of patients. […] Treatment goals in CVS are to identify and avoid triggering factors, prevent recurrent acute episodes with prophylactic medication therapy, ameliorate acute episodes with abortive treatment and supportive care, and provide psychological support to the patient and family. […] The goal of therapy for remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine pharmacotherapies show an overall reduction or remission of CVS symptoms in more than 70% of patients.

• #1 Cyclic Vomiting Syndrome Treatment & Management: Approach Considerations, Avoidance of Triggers, Prophylactic and Abortive Pharmacologic Therapy

  https://emedicine.medscape.com/article/933135-treatment

  Avoidance of triggers […] In some cases of CVS, avoiding identified dietary triggers such as chocolate, cheese, and monosodium glutamate (MSG) can prevent episodes without the use of medication. […] Keeping a detailed diary that records the frequency of vomiting episodes, the type of meal consumed before each episode, and potentially aggravating life events can help patients identify and avoid triggers. […] Sleep deprivation is also cited as a common trigger for patients with CVS, and proper sleep hygiene should be emphasized. […] Pharmacologic therapy is used to prevent episodes of vomiting or to decrease their frequency and also to abort or attenuate episodes once they begin. […] Preventive medications are normally used in patients with more than a single episode of CVS per month.

• #1 Cyclic Vomiting Syndrome: Causes, Treatment, and More

  https://www.healthline.com/health/cyclic-vomiting-syndrome

  The best way to prevent episodes is to avoid your CVS triggers. […] Common CVS triggers include: physical or emotional stress and anxiety, physical overexertion, emotional excitement, lack of sleep, certain foods, alcohol, exposure to extreme temperatures, allergies, prolonged periods without eating. […] For certain triggers, like menstruation, medication and reducing other triggers may help.

• #1 Cyclic Vomiting Syndrome: Symptoms, Causes & Triggers, Treatment

  https://my.clevelandclinic.org/health/diseases/14894-cyclic-vomiting-syndrome

  You can reduce your risk of an episode by avoiding triggers and taking medications as prescribed by your healthcare provider. Other tips include: […] Recognizing and avoiding triggers can reduce your risk of a CVS episode. […] Treat allergies and sinus problems immediately. […] Stay active, but dont over-exercise. […] Avoid food and food additive triggers. […] Avoid extreme diets or fasting. […] Get the right amount of sleep. […] Manage stress and anxiety.

• #1 Treatment of Cyclic Vomiting Syndrome – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome/treatment

  Knowing and managing your triggers can help prevent cyclic vomiting syndrome, especially during the well phase. […] You should also get enough sleep and rest […] treat infections and allergies […] learn how to reduce or manage stress and anxiety […] avoid foods and food additives that trigger episodes. […] During the well phase, your doctor may prescribe medicines to help prevent episodes and how often and how severe they are, such as amitriptyline (Elavil), cyproheptadine (Periactin), propranolol (Inderal), topiramate (Topamax), zonisamide (Zonegran). […] Your doctor may also recommend coenzyme Q10, levocarnitine (L-carnitine), or riboflavin as dietary supplements to help prevent episodes.

• #1

  https://www.bsg.org.uk/web-education/cyclic-vomiting-syndrome

  Cyclic vomiting syndrome is a disorder of gut-brain interaction, and the biopsychosocial model can be used to conceptualise the genesis, evolution, and treatment of the disease. […] Recommendations for the management of CVS revolve around the biopsychosocial model, and the overall aim is to prevent future attacks and abort symptoms acutely. […] Triggers for CVS, which can be identified and avoided with the aid of a symptom diary, can vary between individuals and can include stressful events (both positive and negative), travel/motion sickness, sleep deprivation, and food. Unfortunately, some triggers, such as menstruation (catamenial CVS) and changes in weather conditions, are unavoidable. Techniques such as meditation, relaxation, and sleep hygiene are important non-pharmacological treatments in prophylaxis.

• #1 Cyclic vomiting syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161

  Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes. While you may feel well between episodes, it’s very important to take medications as prescribed by your doctor. […] If episodes occur more than once a month or require hospitalization, your doctor may recommend preventive medicine, such as amitriptyline, propranolol (Inderal), cyproheptadine and topiramate. […] Lifestyle changes also may help, including: getting adequate sleep, for children, downplaying the importance of upcoming events because excitement can be a trigger, avoiding trigger foods, such as alcohol, caffeine, cheese and chocolate, eating small meals and low-fat snacks daily at regular times.

• #1 Cyclical Vomiting Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/cyclical-vomiting-syndrome-pro

  This is not always possible. However, the following should be recommended to patients: […] They should have adequate sleep and avoid exhaustion. […] Any stress or anxiety should be addressed and managed. […] Foods that trigger episodes should be avoided. […] Medications used for migraine prophylaxis can be beneficial for some cases.

• #1 Cyclic Vomiting Syndrome – What You Need to Know

  https://www.drugs.com/cg/cyclic-vomiting-syndrome.html

  Avoid triggers. Certain foods can trigger episodes, such as chocolate, cheese, and monosodium glutamate (MSG). Caffeine can also trigger an episode. Your healthcare provider or dietitian can help you identify foods that trigger an episode. This will help you create meal plans to avoid those triggers. Other triggers include too much exercise, motion sickness, or being in hot weather too long. […] Drink more liquids as directed. Vomiting can lead to dehydration. It is important to drink more liquids to help replace lost body fluids. Ask your provider how much liquid to drink each day and which liquids are best for you. Your provider may recommend that you drink an oral rehydration solution (ORS). An ORS contains water, salts, and sugar that are needed to replace the lost body fluids. Ask what kind of ORS to use, how much to drink, and where to get it.

• #1 Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association. | Population Health Sciences

  https://phs.weill.cornell.edu/research-collaboration/publications/guidelines-management-cyclic-vomiting-syndrome-adults-american

  The committee makes recommendations for the prophylaxis of CVS, treatment of acute attacks, diagnosis, and overall management of CVS. […] The committee strongly recommends that adults with moderate-to-severe CVS receive a tricyclic antidepressant (TCA), such as amitriptyline, as a first-line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. […] Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L-carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. […] The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. […] Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well-being and patient care outcomes.

• #1 Cyclic Vomiting Syndrome – What You Need to Know

  https://www.drugs.com/cg/cyclic-vomiting-syndrome.html

  Eat smaller meals, more often. Eat small amounts of food every 2 to 3 hours, even if you are not hungry. Food in your stomach may decrease your nausea. Avoid long periods of time without eating. […] Control stress. Stress or anxiety can trigger an episode. Find ways to relax and manage your stress. Get more rest and sleep. […] Do not drink alcohol. Alcohol may upset or irritate your stomach. Too much alcohol can also cause nausea and vomiting. […] Do not use marijuana (cannabis). Repeated use of marijuana over a long period of time (chronic use) can cause episodes. This is called cannabis hyperemesis syndrome. Ask your provider for information if you want to quit using marijuana and need help quitting.

• #1 Cyclic Vomiting Syndrome Treatment & Management: Approach Considerations, Avoidance of Triggers, Prophylactic and Abortive Pharmacologic Therapy

  https://emedicine.medscape.com/article/933135-treatment

  The mainstays of prophylactic therapy include the following: Cyproheptadine, Amitriptyline, Anticonvulsants such as topiramate, zonisamide, and levetiracetam, Propranolol, Phenobarbital, Erythromycin. […] Daily prophylactic pharmacotherapy may be used to prevent episodes that occur more than once a month or if they are extremely severe and disabling (eg, lasting 3 days or longer). […] The guidelines formulated by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommend cyproheptadine as first-line therapy in children younger than 5 years. […] Guidelines on the management of CVS in adults from the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association strongly recommend a tricyclic antidepressant, such as amitriptyline, as a first-line prophylactic medication for adults with moderate to severe CVS.

• #1 Cyclic Vomiting Syndrome: AGA Issues Practice Update on Diagnosis and Management – Clinical Advisor

  https://www.clinicaladvisor.com/features/cyclic-vomiting-syndrome-cvs/

  Patients with moderate-severe CVS should receive prophylactic treatment. Experts state that the goal of prophylactic medications in CVS is to prolong the well phase and/or reduce the severity and length of the emetic phase. The ANMS-CVSA guidelines recommend the following prophylactic treatments based on case series and expert opinion: […] Some lifestyle modifications recommended to patients include attempting to avoid triggers, maintaining a regular sleep schedule, avoiding prolonged fasting, and practicing stress management techniques.

• #1 Cyclic Vomiting Syndrome: Diagnostic Criteria and Insights into Long Term Treatment Outcomes – Practical Gastro

  https://practicalgastro.com/2015/01/05/cyclic-vomiting-syndrome-diagnostic-criteria-and-insights-into-long-term-treatment-outcomes/

  Long term treatment of CVS is based on trying to identify the etiologic subgroups particularly the role of psychological stress while prescribing prophylactic drug and abortive therapy and supportive measures to ameliorate acute vomiting episodes. […] Long term management is focused on reducing and actually preventing future hyperemesis episodes. […] At the forefront of CVS management, tricyclic antidepressants (TCA), especially amitriptyline, have been shown to be effective for pharmacological prophylaxis. […] The treatment approach with tricyclic antidepressants requires beginning with a low initial dose of amitriptyline 10 mg at night with incremental increases in 10 mg doses every 2 to 4 weeks to titrate to the desired therapeutic effect. […] Long term outcomes are now becoming apparent as treatment patterns become recognized. One pattern requires further increasing the maintenance dose overtime due to some dose tolerance slowly occurring with breakthrough vomiting cycles.

• #1 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2015.18.4.224

  Cyclic vomiting syndrome (CVS) has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. […] Preventive management is primarily avoidance of triggers; adequate sleep to prevent exhaustion; treating allergies and sinus problems and instituting measures for reducing stress and anxiety. […] Prophylactic treatment options include medications and supplements during symptom free periods. […] For children 5 years old or less, the medication of choice is cyproheptadine at 0.25-0.5 mg/kg/day, dose divided two or three times a day. […] The second choice is propranolol at 0.25-1.0 mg/kg/day, dose divided two or three times a day. […] For those above 6 years of age, amitriptyline at 1.0 to 1.5 mg/kg at bedtime is the first choice, followed by propranolol. […] Supplements that have been shown to help include L-carnitine 50-100 mg per day divided into 2 or 3 doses to a maximum of 1 gm thrice a day, and coenzyme Q-10, 10 mg per kg per day in two or three divided doses up to a maximum of 100 mg thrice a day.

• #1 A New Approach to the Prophylaxis of Cyclic Vomiting: Topiramate

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm16035

  The efficacy of topiramate was superior to propranolol for the prophylaxis of pediatric cyclic vomiting syndrome. […] In our study, we compared the efficacy and safety of propranolol and topiramate in preventing pediatric CVS. […] In our study, the response rate for topiramate was 94%. Our results were inconsistent with the findings of Kumar et al. […] To our knowledge, this is the first study to compare the efficacy of propranolol and topiramate for CVS prophylaxis in pediatric patients. […] The results of our study show that topiramate was superior to propranolol for the management of CVS. […] In conclusion, the efficacy of topiramate was superior to that of propranolol for pediatric CVS. Adverse effect rates did not differ between the treatment groups. Further open-label and controlled trials with larger sample sizes, longer treatment periods and additional test drugs should be conducted on investigating optimal treatment in pediatric CVS.

• #1 Prognosis of Cyclic Vomiting Syndrome | Pediatric Neurology Briefs

  https://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-30-1-5

  Investigators from Teikyo University School of Medicine, Tokyo, Japan, evaluated the clinical features, prognosis, and prophylaxis of cyclic vomiting syndrome and the relationship between the syndrome and levels of adrenocorticotropic/antidiuretic hormones (ACTH/ADH). […] Prophylactic therapy was started for 18 patients with severe symptoms; valproic acid (VA), VA with phenobarbital, phenobarbital, and amitriptyline were effective in 9, 4, 3, and 1 patient, respectively. […] Most patients with cyclic vomiting syndrome recovered completely and responded to prophylactic therapy, but half of the patients developed migraine.

• #1 Cyclic vomiting syndrome: From pathophysiology to treatment | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-cyclic-vomiting-syndrome-from-pathophysiology-articulo-S2255534X24000616

  In patients that do not tolerate TADs, anticonvulsants, such as zonisamide or levetiracetam, can be considered. Aprepitant is currently recommended as an alternative prophylactic treatment in patients that do not respond to or do not tolerate standard therapy with amitriptyline or topiramate. Coenzyme Q10 is recommended as monotherapy or in combination with prophylactic medications. […] The recognition of this subtype highlights the importance of a deeper understanding of the pathologic mechanisms of CVS, consequently providing highly efficacious personalized treatment. […] Given that chronic cannabis consumption is associated with the lack of treatment response, its use should be suspended. […] Patients usually benefit from a multidisciplinary approach that includes the gastroenterologist, psychologist/psychiatrist, and nursing personnel familiarized with the syndrome.

• #1

  https://journals.lww.com/ajg/fulltext/2011/10002/cyclic_vomiting_syndrome__cvs___a_management.1078.aspx

  Numerous medications are used for prophylaxis, although the quality of evidence to support these agents is limited to anecdotal reports and poorly controlled clinical trials. […] It is recommended to use a sequential trial of agents starting with the safest agents first (pizotifen, cyproheptadine, propranolol, carnitine), before progressing to TCA’s or anticonvulsants. Further management focuses on controlling episode triggers like anxiety, stress, infection, exercise, trauma, menstruation, or other triggers.

• #1 Efficacy of Coenzyme Q10 in the Treatment of Cyclic Vomiting Syndrome in Children

  https://austinpublishinggroup.com/pediatrics-child-health-care/fulltext/jpchc-v6-id1038.php

  CoQ10 is an efficient and safe treatment of CVS and should be used as the first line treatment in this episodic syndrome related to migraine. […] Considering that, compared to the other drugs used in CVS, CoQ10 has a very favorable safety profile and after a very positive experience (complete disappearance of CVS in a very severe patient only treated by CoQ), we designed this study to evaluate the efficacy of CoQ10 in monotherapy as the first line treatment of CVS. […] The primary objective was to demonstrate a reduction (of at least 50%) in the number of vomiting crisis under CoQ10 treatment. […] CoQ10 has 83% of response rate over 50% and 74% obtained a reduction of 70% and more. […] Considering the level of efficacy associated to the excellent safety profile, CoQ10 should be the first line treatment in patients in whom the initial evaluation did not find anxiety or clear dysautonomic signs. […] We demonstrate the efficacy of CoQ10 as monotherapy in the prophylactic treatment of CVS, which supports the hypothesis for a mitochondrial origin to this syndrome. The favorable safety profile of CoQ10 makes it a good candidate for the first line treatment of CVS.

• #1 Comparison of the Effect of Adding L-Carnitine to Propranolol in the Prevention of Cyclic Vomiting Syndrome Attacks in Children

  https://www.jimc.ir/article_159849.html

  Prophylaxis should be considered in children with frequent or severe periods. Prevention and treatment of CVS in children is very difficult and no specific and effective treatment has been proven in clinical trials. Propranolol is approved for the prophylaxis of CVS in children of all ages, but its effectiveness has been variable. […] Our research revealed that combination of low dose propranolol with L-Carnitine has comparable efficacy with high dose Propranolol in prophylaxis of CVS. […] The aim of this study was to compare the effect of standard dose of propranolol with combination of L-carnitine and low dose propranolol in prophylaxis of CVS, which showed that two groups had approximately the same response. […] The current research revealed that the combination of low dose Propranolol and L-Carnitine has comparable efficacy with high dose Propranolol.

• #1 Cyclic Vomiting Syndrome: Recognition and Guidelines for Treatment | UPMC Physician Resources

  https://www.upmcphysicianresources.com/news/011822-cyclic-vomiting-syndrome

  CVS is treated with prophylactic therapies, such as preventive medication and identifying and avoiding triggers, and abortive therapies for relief when an attack occurs. Most patients respond to readily available medications. For prophylaxis, tricyclic antidepressants, such as amitriptyline, are strongly recommended as a first-line medication in patients with moderate-to-severe CVS. […] Topiramate or aprepitant are recommended as alternative prophylactic medications. Prophylactic lifestyle changes include identifying and avoiding triggers, regular exercise, good sleep hygiene, stress management, avoiding fasting and dehydration, and avoiding cannabis and opiates. Additionally, evidence-based psychotherapy may be indicated to address psychiatric comorbidities that can contribute to CVS.

• #1 Cyclic vomiting syndrome: From pathophysiology to treatment | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-cyclic-vomiting-syndrome-from-pathophysiology-articulo-S2255534X24000616

  Cyclic vomiting syndrome (CVS) is a chronic disorder characterized by episodes of uncontrollable vomiting that are interspersed with asymptomatic or minimal symptom periods. Management of CVS typically involves a multidisciplinary approach. Pharmacologic options are explored, such as antiemetics and preventive medications, as well as behavioral and psychologic support therapies. Treatment personalization is essential, adapting it to the individual needs of each patient. […] During the inter-episodic phase, treatment is prophylactic and is recommended in patients with moderate/severe disease, i.e., in patients with 4 episodes per year of nausea and severe vomiting that make the patient seek help at the emergency service or require hospitalization. TADs are the first-line drugs for CVS prophylaxis and have been shown to reduce the duration, severity, and frequency of episodes, as well as the number of emergency room visits and hospitalizations.

• #1 Cyclic vomiting syndrome: Treatment, diagnosis, symptoms, and causes

  https://www.medicalnewstoday.com/articles/cyclic-vomiting-syndrome

  It is not possible to prevent the onset of CVS, but a person can take the following steps to reduce the frequency and severity of episodes. […] Identify specific triggers and avoid exposure to them. […] Continue to take prescribed medication, even when feeling well. […] Get quality sleep regularly. […] Treat any allergies, sinus problems, or other illnesses or infections right away. […] Practice ways of managing stress and anxiety. […] Have regular meals. […] Stay in touch with the doctor and discuss methods of prevention and any changes in symptoms.

• #1

  https://link.springer.com/article/10.1007/s00431-018-3218-7

  If standard agents are either ineffective or poorly tolerated, other medications are used including antiemetics such as aprepitant, anticonvulsants, mitochondrial supplements as well as prokinetic agents, other tricyclic or tetracyclic antidepressants, and Ca2+-channel blockers. […] The four components include drinking sufficient (at least maintenance) fluids, eating regularly without skipping meals, exercising regularly (as many become deconditioned), and good sleep hygiene. […] The identification of a specific trigger that can be avoided (e.g., dietary monosodium glutamate, sleepovers) can also reduce numbers of episodes. […] When the patient fails to respond to standard therapy, inadequate compliance is common in affected adolescents and can be documented by prescription refills and blood levels for amitriptyline.

• #1 Cyclic Vomiting Syndrome (CVS) – IFFGD

  https://iffgd.org/gi-disorders/upper-gi-disorders/cyclic-vomiting-syndrome-cvs/

  In general, treatment includes avoiding potential triggering factors, taking medicines to prevent episodes or reduce symptoms, and getting supportive care during episodes. […] Triggering factors like stress, anxiety, or certain foods will vary between persons. Try to identify and avoid triggers. […] Drug treatments may be divided into short-term treatment of the vomiting episodes and long-term treatment to try to prevent the episodes. […] Long term, a tricyclic antidepressant can help prevent nausea and vomiting. Other medicines may also be used as preventive therapies. […] A letter from your doctor that describes your Cyclic Vomiting Syndrome diagnosis and the right treatment for you is often helpful to have on hand. Having a planned, quick, effective treatment helps put care into action early if emergency treatment is needed. It also helps reduce worry. Planned support and early action help improve the treatment of CVS.

• #1 About cyclic vomiting syndrome | Children’s Wisconsin

  https://childrenswi.org/medical-care/gastroenterology-liver-and-nutrition-program/conditions/cyclic-vomiting-syndrome

  Cyclic vomiting syndrome is one of the more unrecognized, misdiagnosed and mysterious childhood diseases. […] Treatment for CVS is a combination of lifestyle and medications. Neuromostimulation is also an effective treatment. Healthy lifestyle such as in migraine management is also helpful for kids living with CVS. Strategies include ensuring consistent sleep routines, eating nutritious meals on a schedule, addressing triggers for CVS episodes, and using stress management tools as needed. Your child’s CVS provider will give you a comprehensive treatment plan. […] Its important to track and understand the triggers for your child’s vomiting episodes. Triggers can include infectious illness, negative or positive stress/excitement, poor sleep, fatigue and occasionally excess sugar/junk food, caffeine, nitrites, or monosodium glutamate (MSG) in foods. […] If your child has been missing school for CVS or other symptoms, it is important to talk to your health care team about ways to limit the impact of CVS on school and daily life. Sometimes this includes support from the psychologist and help with developing a pro-active plan for school.

• #1 Cyclic Vomiting Syndrome: Diagnostic Criteria and Insights into Long Term Treatment Outcomes – Practical Gastro

  https://practicalgastro.com/2015/01/05/cyclic-vomiting-syndrome-diagnostic-criteria-and-insights-into-long-term-treatment-outcomes/

  The important message for our clinicians is that CVS can be presented to the patient as a potentially reversible disease: Following initial intensive treatment to achieve remission and after effectively addressing comorbidities, the dose of amitriptyline can be slowly tapered and even stopped over time.

• #2 Cyclic vomiting syndrome: diagnostic approach and current management s | CEG

  https://www.dovepress.com/cyclic-vomiting-syndrome-diagnostic-approach-and-current-management-st-peer-reviewed-fulltext-article-CEG

  Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of nausea and vomiting lasting for 15 days followed by asymptomatic periods. […] Current management strategies include trigger avoidance, abortive and prophylactic medication therapies, and supportive care. The goal of therapy for the remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine medications show an overall reduction or remission of CVS symptoms in more than 70% of patients. […] Treatment goals in CVS are to identify and avoid triggering factors, prevent recurrent acute episodes with prophylactic medication therapy, ameliorate acute episodes with abortive treatment and supportive care, and provide psychological support to the patient and family. […] The goal of therapy for remission phase is prophylaxis of further episodes. Antidepressant, antiepileptic, and antimigraine pharmacotherapies show an overall reduction or remission of CVS symptoms in more than 70% of patients.

• #2 High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-102

  Cyclic vomiting syndrome (CVS), defined by recurrent stereotypical episodes of nausea and vomiting, is a relatively-common disabling and historically difficult-to-treat condition associated with migraine headache and mitochondrial dysfunction. Limited data suggests that the anti-migraine therapies amitriptyline and cyproheptadine, and the mitochondrial-targeted cofactors co-enzyme Q10 and L-carnitine, have efficacy in episode prophylaxis. […] Our data suggest that a protocol consisting of mitochondrial-targeted cofactors (co-enzyme Q10 and L-carnitine) plus amitriptyline (or possibly cyproheptadine in preschoolers) coupled with blood level monitoring is highly effective in the prevention of vomiting episodes. […] A trial first of cofactors and fasting avoidance alone may be warranted in cases without a history of multiple hospitalizations for vomiting episodes.

• #2 Recent Concepts on Cyclic Vomiting Syndrome in Children

  https://www.jnmjournal.org/journal/view.html?uid=135&vmd=Full

  Prophylaxis of symptomatic vomiting episodes is focused on the identification and avoidance of triggering factors and prophylactic drugs. If precipitants causing vomiting episodes can be identified in each patient, it may be possible to prevent the attacks of episodes by avoiding stressful events, infection, specific foods, sleep deprivation, triggering foods (chocolate and cheese), and motion sickness. […] Medical prophylaxis in children with CVS is composed of various medicines that are known to be somewhat effective in preventing vomiting episodes: amitriptyline, cyproheptadine, propranolol, etc. […] Although most prophylactic medications are relatively safe even in children, heart rate monitoring and electrocardiogram monitoring are required while administering and dosing up propronolol and amitriptyline because these drugs can cause bradycardia and arrhythmia, respectively, as side effects. […] Further studies are needed in the future on the effective prophylaxis of CVS based on its pathogenesis.

• #2 Cyclical Vomiting Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/cyclical-vomiting-syndrome-pro

  This is not always possible. However, the following should be recommended to patients: […] They should have adequate sleep and avoid exhaustion. […] Any stress or anxiety should be addressed and managed. […] Foods that trigger episodes should be avoided. […] Medications used for migraine prophylaxis can be beneficial for some cases.

• #2 A New Approach to the Prophylaxis of Cyclic Vomiting: Topiramate

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm16035

  The aim of this study was to compare the efficacy and tolerability of topiramate and propranolol in preventing pediatric cyclic vomiting syndrome. […] Prophylactic treatment is proposed to prevent recurrent episodes, abortive treatment and/or supportive care to ameliorate acute episodes. […] Preventive treatment with tricyclic antidepressants, -adrenoceptor antagonists (propranolol) or cyproheptadine have been shown to be safe and effective in pediatric patients with CVS. […] Also, drugs such as pizotifen, erythromycin, coenzyme Q10, and antiepileptics including valproate, phenobarbital, and topiramate can be used for CVS prophylaxis. […] Topiramate, an antiepileptic medication, has been used with increasing frequency in the treatment of non-epileptic periodic anomalies including headaches, abdominal migraine, and CVS.

• #2 Cyclic Vomiting Syndrome Causes, Symptoms, Diet, Treatment

  https://www.medicinenet.com/cyclic_vomiting_syndrome_cvs/article.htm

  Is it possible to prevent cyclic vomiting syndrome? […] To help prevent and/or reduce cyclic vomiting attacks: […] Get adequate sleep. […] Seek help to prevent stress and anxiety. […] Seek help if your CVS is caused or exacerbated by recreational drug over-use. […] Treat infections and/or allergies early. […] Avoid any triggers of CVS, especially related to foods. […] During the symptom-free phase, eat a balanced diet with regular meals. […] Utilize appropriate medications prescribed by a physician to reduce CVS symptoms.

• #2

  https://foodguides.com/blogs/from-the-experts/cyclic-vomiting-syndrome-cvs-in-adults-causes-phases-and-management-strategies

  Identifying triggering foods for some people may be a challenge. Because it can be challenging, I encourage you to keep a log. A log will help you find trends in foods, moods, etc, that may help identify what is triggering your episodes of CVS. One good one to keep in mind is called mySymptoms Food Diary. This app is a diary for tracking food, bowel health, stress, sleep, mood, medications, and symptoms. […] Once you know your triggers, it may be easier to help keep CVS episodes at bay or to a minimum. […] During an episode, staying in bed and sleeping in a dark, quiet room is recommended. Once the vomiting is over, its necessary to drink fluids with electrolytes – like Gatorade, Powerade, Body Armor, and coconut water. […] When not experiencing active CVS episodes, the average adult should drink between 9 and 13 cups of water daily.

• #2 Expert diagnosis and treatment of cyclic vomiting syndrome | Digestive Health Services | University Hospitals | Cleveland, OH | University Hospitals

  https://www.uhhospitals.org/services/digestive-health-services/conditions-and-treatments/stomach-disorders/conditions-and-treatments/cyclic-vomiting-syndrome

  There is no cure for CVS although many children may grow out of the syndrome. […] Treatment will usually revolve around controlling the triggers through lifestyle changes and/or medications, including anti-nausea and migraine therapies. […] Lifestyle changes may include: […] Avoiding foods that may have triggered past episodes, which may include chocolate, cheese and foods containing monosodium glutamate (MSG) […] Avoiding or minimizing alcohol intake […] Eating smaller meals and low-fat snacks on a regular schedule […] Minimizing the excitement and anticipation before certain events, particularly in children […] Maintaining general good health, including oral hygiene […] Getting plenty of sleep.

• #2 Cyclic vomiting syndrome: Treatment, diagnosis, symptoms, and causes

  https://www.medicalnewstoday.com/articles/cyclic-vomiting-syndrome

  It is not possible to prevent the onset of CVS, but a person can take the following steps to reduce the frequency and severity of episodes. […] Identify specific triggers and avoid exposure to them. […] Continue to take prescribed medication, even when feeling well. […] Get quality sleep regularly. […] Treat any allergies, sinus problems, or other illnesses or infections right away. […] Practice ways of managing stress and anxiety. […] Have regular meals. […] Stay in touch with the doctor and discuss methods of prevention and any changes in symptoms.

• #2 Cyclic Vomiting Syndrome – What You Need to Know

  https://www.drugs.com/cg/cyclic-vomiting-syndrome.html

  Eat smaller meals, more often. Eat small amounts of food every 2 to 3 hours, even if you are not hungry. Food in your stomach may decrease your nausea. Avoid long periods of time without eating. […] Control stress. Stress or anxiety can trigger an episode. Find ways to relax and manage your stress. Get more rest and sleep. […] Do not drink alcohol. Alcohol may upset or irritate your stomach. Too much alcohol can also cause nausea and vomiting. […] Do not use marijuana (cannabis). Repeated use of marijuana over a long period of time (chronic use) can cause episodes. This is called cannabis hyperemesis syndrome. Ask your provider for information if you want to quit using marijuana and need help quitting.

• #2 Cyclic vomiting syndrome

  https://www.mymlc.com/health-information/diseases-and-conditions/c/cyclic-vomiting-syndrome2/?section=Prevention

  Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes. While you may feel well between episodes, it’s very important to take medications as prescribed by your doctor. […] If episodes occur more than once a month or require hospitalization, your doctor may recommend preventive medicine, such as amitriptyline, propranolol (Inderal), cyproheptadine and topiramate. […] Lifestyle changes also may help, including: getting adequate sleep, for children, downplaying the importance of upcoming events because excitement can be a trigger, avoiding trigger foods, such as alcohol, caffeine, cheese and chocolate, eating small meals and low-fat snacks daily at regular times.

• #2 Cyclic Vomiting Syndrome: Recognition and Guidelines for Treatment | UPMC Physician Resources

  https://www.upmcphysicianresources.com/news/011822-cyclic-vomiting-syndrome

  CVS is treated with prophylactic therapies, such as preventive medication and identifying and avoiding triggers, and abortive therapies for relief when an attack occurs. Most patients respond to readily available medications. For prophylaxis, tricyclic antidepressants, such as amitriptyline, are strongly recommended as a first-line medication in patients with moderate-to-severe CVS. […] Topiramate or aprepitant are recommended as alternative prophylactic medications. Prophylactic lifestyle changes include identifying and avoiding triggers, regular exercise, good sleep hygiene, stress management, avoiding fasting and dehydration, and avoiding cannabis and opiates. Additionally, evidence-based psychotherapy may be indicated to address psychiatric comorbidities that can contribute to CVS.

• #2

  https://wexnermedical.osu.edu/-/media/transcripts/wexnermedical/healthcare-services/digestive-diseases/cyclic-vomiting-syndrome/pyehkaxmz1a_how-to-prevent-a-cyclic-vomiting-episode-with-prophylactic-therapy.txt

  The other nice thing is it really is very well tolerated in patients. […] Then, finally, we have some supplements that you can actually get over the counter. […] It’s very important to treat stress and anxiety, and so on. […] In fact, we did a study. We found that meditation can actually improve outcomes. It improves coping in patients with cyclic vomiting syndrome and improved their sleep and improved quality of life. […] I think it’s very important to really prevent these CVS episodes so that people can carry on with their lives. If you have moderate to severe CVS, the recommendation is that we start what is called prophylactic or preventive medications in these patients. […] It’s very important to learn how to administer these medications/get comfortable with these medications because there’s actually data to show that even gastroenterologists are not comfortable prescribing some of these medications.

• #2 Cyclic vomiting syndrome: From pathophysiology to treatment | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-cyclic-vomiting-syndrome-from-pathophysiology-articulo-S2255534X24000616

  In patients that do not tolerate TADs, anticonvulsants, such as zonisamide or levetiracetam, can be considered. Aprepitant is currently recommended as an alternative prophylactic treatment in patients that do not respond to or do not tolerate standard therapy with amitriptyline or topiramate. Coenzyme Q10 is recommended as monotherapy or in combination with prophylactic medications. […] The recognition of this subtype highlights the importance of a deeper understanding of the pathologic mechanisms of CVS, consequently providing highly efficacious personalized treatment. […] Given that chronic cannabis consumption is associated with the lack of treatment response, its use should be suspended. […] Patients usually benefit from a multidisciplinary approach that includes the gastroenterologist, psychologist/psychiatrist, and nursing personnel familiarized with the syndrome.

• #2

  https://link.springer.com/article/10.1007/s00431-018-3218-7

  Cyclic vomiting syndrome (CVS) in children is characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. […] Comprehensive management begins with lifestyle alterations, and extends to medications, supplements, and stress reduction therapies. […] New prophylactic approaches include NK1 antagonists and higher dosages of amitriptyline. […] Prophylactic medications are recommended in children with frequent (every 4-6 weeks) or severe (exceeding 2 days or requiring hospitalization) episodes. […] The NASPGHAN Consensus Statement recommended cyproheptadine and amitriptyline for children 5 years and those 5 years of age, respectively, with propranolol serving as a second-line agent. […] Although amitriptyline, a tricyclic antidepressant, appears to be the most efficacious and widely used agent, side effects (anticholinergic, cardiac, behavioral) are noted in up to half of treated children and limit its use.

• #2 Cyclic Vomiting Syndrome: Diagnostic Criteria and Insights into Long Term Treatment Outcomes – Practical Gastro

  https://practicalgastro.com/2015/01/05/cyclic-vomiting-syndrome-diagnostic-criteria-and-insights-into-long-term-treatment-outcomes/

  Long term treatment of CVS is based on trying to identify the etiologic subgroups particularly the role of psychological stress while prescribing prophylactic drug and abortive therapy and supportive measures to ameliorate acute vomiting episodes. […] Long term management is focused on reducing and actually preventing future hyperemesis episodes. […] At the forefront of CVS management, tricyclic antidepressants (TCA), especially amitriptyline, have been shown to be effective for pharmacological prophylaxis. […] The treatment approach with tricyclic antidepressants requires beginning with a low initial dose of amitriptyline 10 mg at night with incremental increases in 10 mg doses every 2 to 4 weeks to titrate to the desired therapeutic effect. […] Long term outcomes are now becoming apparent as treatment patterns become recognized. One pattern requires further increasing the maintenance dose overtime due to some dose tolerance slowly occurring with breakthrough vomiting cycles.

• #2 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2015.18.4.224

  Cyclic vomiting syndrome (CVS) has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. […] Preventive management is primarily avoidance of triggers; adequate sleep to prevent exhaustion; treating allergies and sinus problems and instituting measures for reducing stress and anxiety. […] Prophylactic treatment options include medications and supplements during symptom free periods. […] For children 5 years old or less, the medication of choice is cyproheptadine at 0.25-0.5 mg/kg/day, dose divided two or three times a day. […] The second choice is propranolol at 0.25-1.0 mg/kg/day, dose divided two or three times a day. […] For those above 6 years of age, amitriptyline at 1.0 to 1.5 mg/kg at bedtime is the first choice, followed by propranolol. […] Supplements that have been shown to help include L-carnitine 50-100 mg per day divided into 2 or 3 doses to a maximum of 1 gm thrice a day, and coenzyme Q-10, 10 mg per kg per day in two or three divided doses up to a maximum of 100 mg thrice a day.

• #2 Cyclic Vomiting Syndrome Medication: Antiemetic Agents, Antihistamines, 1st Generation, Antidepressants, TCAs, Beta-Adrenergic Blocking Agents, Anticonvulsants, Antibiotics, Anxiolytics, Benzodiazepines

  https://emedicine.medscape.com/article/933135-medication

  Medications used to prevent, ameliorate, or abort vomiting episodes include cyproheptadine, amitriptyline, topiramate, zonisamide, levetiracetam, propranolol, phenobarbital, erythromycin, ondansetron, promethazine, and prochlorperazine. […] Propranolol is a beta-adrenergic blocker and an excellent first-line agent for prophylaxis when used at low doses. It has a 57% efficacy rate, with efficacy defined as a 50% reduction in the frequency and severity of episodes. […] Cyproheptadine is a nonselective antihistamine effective against CVS and migraines. It is also an appetite stimulant. Therapeutic effects are observed within 1-2 weeks. This agent is an excellent choice for children younger than 5 years. […] Tricyclic antidepressants (TCAs) such as amitriptyline are excellent first-line choices in children older than 5 years. […] Beta-blockers may reduce the frequency and severity of episodes.

• #2 A New Approach To The Prophylaxis of Cyclic Vomiting Topiramate | PDF | Migraine | Adverse Effect

  https://www.scribd.com/document/399369093/A-New-Approach-to-the-Prophylaxis-of-Cyclic-Vomiting-Topiramate

  This study compared the efficacy of topiramate versus propranolol in preventing attacks of cyclic vomiting syndrome in pediatric patients. […] Topiramate was found to be superior to propranolol, with 81% of topiramate patients reporting freedom from attacks compared to 59% of propranolol patients. […] Topiramate also had higher responder rates, defined as a 50% or greater reduction in attacks per year. […] Both drugs were well-tolerated, with only minor adverse effects reported.

• #2 Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association. | Population Health Sciences

  https://phs.weill.cornell.edu/research-collaboration/publications/guidelines-management-cyclic-vomiting-syndrome-adults-american

  The committee makes recommendations for the prophylaxis of CVS, treatment of acute attacks, diagnosis, and overall management of CVS. […] The committee strongly recommends that adults with moderate-to-severe CVS receive a tricyclic antidepressant (TCA), such as amitriptyline, as a first-line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. […] Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L-carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. […] The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. […] Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well-being and patient care outcomes.

• #2 Cyclic Vomiting Syndrome Treatment & Management: Approach Considerations, Avoidance of Triggers, Prophylactic and Abortive Pharmacologic Therapy

  https://emedicine.medscape.com/article/933135-treatment

  The mainstays of prophylactic therapy include the following: Cyproheptadine, Amitriptyline, Anticonvulsants such as topiramate, zonisamide, and levetiracetam, Propranolol, Phenobarbital, Erythromycin. […] Daily prophylactic pharmacotherapy may be used to prevent episodes that occur more than once a month or if they are extremely severe and disabling (eg, lasting 3 days or longer). […] The guidelines formulated by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommend cyproheptadine as first-line therapy in children younger than 5 years. […] Guidelines on the management of CVS in adults from the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association strongly recommend a tricyclic antidepressant, such as amitriptyline, as a first-line prophylactic medication for adults with moderate to severe CVS.

• #2

  https://link.springer.com/article/10.1007/s00431-018-3218-7

  If standard agents are either ineffective or poorly tolerated, other medications are used including antiemetics such as aprepitant, anticonvulsants, mitochondrial supplements as well as prokinetic agents, other tricyclic or tetracyclic antidepressants, and Ca2+-channel blockers. […] The four components include drinking sufficient (at least maintenance) fluids, eating regularly without skipping meals, exercising regularly (as many become deconditioned), and good sleep hygiene. […] The identification of a specific trigger that can be avoided (e.g., dietary monosodium glutamate, sleepovers) can also reduce numbers of episodes. […] When the patient fails to respond to standard therapy, inadequate compliance is common in affected adolescents and can be documented by prescription refills and blood levels for amitriptyline.

• #2 Efficacy of Coenzyme Q10 in the Treatment of Cyclic Vomiting Syndrome in Children

  https://austinpublishinggroup.com/pediatrics-child-health-care/fulltext/jpchc-v6-id1038.php

  CoQ10 is an efficient and safe treatment of CVS and should be used as the first line treatment in this episodic syndrome related to migraine. […] Considering that, compared to the other drugs used in CVS, CoQ10 has a very favorable safety profile and after a very positive experience (complete disappearance of CVS in a very severe patient only treated by CoQ), we designed this study to evaluate the efficacy of CoQ10 in monotherapy as the first line treatment of CVS. […] The primary objective was to demonstrate a reduction (of at least 50%) in the number of vomiting crisis under CoQ10 treatment. […] CoQ10 has 83% of response rate over 50% and 74% obtained a reduction of 70% and more. […] Considering the level of efficacy associated to the excellent safety profile, CoQ10 should be the first line treatment in patients in whom the initial evaluation did not find anxiety or clear dysautonomic signs. […] We demonstrate the efficacy of CoQ10 as monotherapy in the prophylactic treatment of CVS, which supports the hypothesis for a mitochondrial origin to this syndrome. The favorable safety profile of CoQ10 makes it a good candidate for the first line treatment of CVS.

• #2

  https://www.bsg.org.uk/web-education/cyclic-vomiting-syndrome

  Cyclic vomiting syndrome is a disorder of gut-brain interaction, and the biopsychosocial model can be used to conceptualise the genesis, evolution, and treatment of the disease. […] Recommendations for the management of CVS revolve around the biopsychosocial model, and the overall aim is to prevent future attacks and abort symptoms acutely. […] Triggers for CVS, which can be identified and avoided with the aid of a symptom diary, can vary between individuals and can include stressful events (both positive and negative), travel/motion sickness, sleep deprivation, and food. Unfortunately, some triggers, such as menstruation (catamenial CVS) and changes in weather conditions, are unavoidable. Techniques such as meditation, relaxation, and sleep hygiene are important non-pharmacological treatments in prophylaxis.

• #2 Cyclic Vomiting Syndrome | Melbourne Headache Centre

  https://melbourneheadachecentre.com.au/conditions/cyclic-vomiting-syndrome/

  Prophylaxis/Preventive medications may be recommended if the condition is considered moderate to severe (more than 4 episodes per year), severe nausea and vomiting, recurrent hospital ED visits and inability to maintain normal activities of daily living. […] While it doesnt offer a solution for everyone, getting it checked and treated comes with no side effects (maybe a little tenderness on the point of pressure), but offers the potential for rapid (sometimes immediate) and sustained relief. […] The non-drug answer and treatment for many sufferers of cyclic vomiting syndrome lies in the close connection between the headache centre in the brainstem and one of the key controls in the brainstem for nausea and vomiting. […] Screening for co-morbid conditions (anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance abuse). […] Alternate techniques like meditation, relaxation, and biofeedback may be offered to improve overall wellbeing and patient care outcomes but research is needed to indicate efficacy.

• #2 Cyclic Vomiting Syndrome – GI for Kids

  https://www.giforkids.com/cyclic-vomiting-syndrome/

  It is important to pay attention to potential triggers as prevention plays a major role in treating CVS. Avoiding or eliminating these triggers can reduce the frequency of episodes, such as cutting out certain foods or drinks. […] There are no specific medications just for cyclic vomiting syndrome. Prevention is key, but like abdominal migraines, tricyclic antidepressants and migraine medications may also be effective in preventing or reducing episodes.

• #2 UC San Diego Health Health Library | San Diego Hospital, Healthcare

  https://myhealth.ucsd.edu/3,90915

  Cyclic vomiting syndrome (CVS) is an uncommon health problem in adults. Treatment for CVS may include: […] Certain medicines may help stop vomiting and nausea. You may need to take them regularly to prevent an attack. […] Trying to stay away from triggers such as stress or certain foods may help prevent symptoms. Meditation, relaxation, mindfulness, and biofeedback may help. […] Not using cannabis helps prevent symptoms in this type of cyclic vomiting syndrome.

• #2 About cyclic vomiting syndrome | Children’s Wisconsin

  https://childrenswi.org/medical-care/gastroenterology-liver-and-nutrition-program/conditions/cyclic-vomiting-syndrome

  Cyclic vomiting syndrome is one of the more unrecognized, misdiagnosed and mysterious childhood diseases. […] Treatment for CVS is a combination of lifestyle and medications. Neuromostimulation is also an effective treatment. Healthy lifestyle such as in migraine management is also helpful for kids living with CVS. Strategies include ensuring consistent sleep routines, eating nutritious meals on a schedule, addressing triggers for CVS episodes, and using stress management tools as needed. Your child’s CVS provider will give you a comprehensive treatment plan. […] Its important to track and understand the triggers for your child’s vomiting episodes. Triggers can include infectious illness, negative or positive stress/excitement, poor sleep, fatigue and occasionally excess sugar/junk food, caffeine, nitrites, or monosodium glutamate (MSG) in foods. […] If your child has been missing school for CVS or other symptoms, it is important to talk to your health care team about ways to limit the impact of CVS on school and daily life. Sometimes this includes support from the psychologist and help with developing a pro-active plan for school.

• #2 Cyclic Vomiting Syndrome

  https://fpnotebook.com/GI/Sx/CyclcVmtngSyndrm1.htm

  Trigger Avoidance […] Prophylactic Medications […] Effective for chronic remission (or reduction of episodes) in 70% of cases […] Prophylactic agents also commonly used in Migraine Headache Prophylaxis […] Tricyclic Antidepressants (e.g. Amitriptyline, Nortriptyline) […] Topiramate […] Propranolol […] Supplements with evidence of benefit […] Coenzyme Q10 […] L-carnitine

• #2 Cyclic Vomiting Syndrome (CVS) – IFFGD

  https://iffgd.org/gi-disorders/upper-gi-disorders/cyclic-vomiting-syndrome-cvs/

  In general, treatment includes avoiding potential triggering factors, taking medicines to prevent episodes or reduce symptoms, and getting supportive care during episodes. […] Triggering factors like stress, anxiety, or certain foods will vary between persons. Try to identify and avoid triggers. […] Drug treatments may be divided into short-term treatment of the vomiting episodes and long-term treatment to try to prevent the episodes. […] Long term, a tricyclic antidepressant can help prevent nausea and vomiting. Other medicines may also be used as preventive therapies. […] A letter from your doctor that describes your Cyclic Vomiting Syndrome diagnosis and the right treatment for you is often helpful to have on hand. Having a planned, quick, effective treatment helps put care into action early if emergency treatment is needed. It also helps reduce worry. Planned support and early action help improve the treatment of CVS.

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