Introduction
Nausea and vomiting are common symptoms encountered in general practice with many potential causes.
Intervention
Brief sniffing of an isopropyl alcohol skin prep swab to relieve nausea and vomiting and reduce the need for other medication.
Indication
For short-term relief of nausea and vomiting in the emergency department, post-operative or general practice settings.
Precautions/Adverse effects
Sniffing isopropyl alcohol is not recommended for use during pregnancy and has not been evaluated for effectiveness in chemotherapy induced nausea.
The reviewed studies did not report any adverse effects. However, follow-up periods were brief. The need for additional rescue anti-nausea treatment was not increased. Given the extremely low doses inhaled, significant harms appear unlikely.
Sniffing can be repeated as needed, but the safety of prolonged use (over several hours) has not been tested. Even with repeated use every 10 minutes, the total dose of isopropyl alcohol is expected to remain very low.
Availability
Swabs are cheap and readily available in most healthcare settings.
Description
Sniffing isopropyl alcohol (as found in standard clinic skin prep swabs) provides rapid but brief relief from nausea and vomiting, with peak effect at around 4 minutes and effectiveness still evident at 10 minutes.1-6 Effectiveness has been shown in post-operative and emergency department settings, with randomised placebo-controlled trials, and this is likely to be applicable to general practice settings. In one trial, nausea scores were reduced by approximately 50% and there was a 33% relative risk reduction in the need for rescue anti-nausea medication.3 It appears more effective and faster acting than ondansetron1,5, and faster acting than other standard therapy.3
Tips and Challenges
Patients should hold the isopropyl alcohol swab 1 to 2 cm below the nares and inhale deeply as often as needed to relieve nausea.
Repeated inhalation can provide continued short-lasting relief. A single swab may dry out after repeated use, in which case a new swab will be required.
Grading
Moderate (We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but further research could have an impact on the estimate.)