Vomiting shortly after taking pills—fish it out & take it again?
October 28, 2023 12:25 AM Subscribe
If you vomit anywhere from five to 30 minutes after taking pills, should you take them again, either by fishing them out or simply re-dosing, or wait until the next dose? Does this calculus change if the (non-sublingual) medication is for nausea? Or perhaps it's an extended release formulation? What if it's expensive, or otherwise hard to get, such as ADHD meds? Are there any general guidelines, e.g., based on pill form factor, dosing schedule, medication type? Doctors have not been terribly helpful with this question.
This is a great question for a PharmD. MDs get a handful of pharmacology lectures; PharmDs spent 4 years studying nothing but.
posted by basalganglia at 12:47 AM on October 28, 2023 [13 favorites]
posted by basalganglia at 12:47 AM on October 28, 2023 [13 favorites]
If you can see the pill in your vomit, I believe you are meant to treat that as a missed dose. The leaflet with your medication should tell you what to do if you miss a dose. If you can't see the pill, it's usually best to assume you have not in fact vomited it up, and not to take it again.
posted by In Your Shell Like at 2:44 AM on October 28, 2023 [5 favorites]
posted by In Your Shell Like at 2:44 AM on October 28, 2023 [5 favorites]
Do not fish pills out of your vomit, please.
posted by Geckwoistmeinauto at 4:48 AM on October 28, 2023 [8 favorites]
posted by Geckwoistmeinauto at 4:48 AM on October 28, 2023 [8 favorites]
In the icu I work at, patients get their meds re-dosed if they vomit within an hour.
posted by obfuscation at 6:53 AM on October 28, 2023 [6 favorites]
posted by obfuscation at 6:53 AM on October 28, 2023 [6 favorites]
I have always heard like above - you see the pill, you haven't taken it.
I don't see how telling them to not fish the pills out is helpful, without additional information. Medication can be expensive, as they noted.
posted by tiny frying pan at 7:31 AM on October 28, 2023 [13 favorites]
I don't see how telling them to not fish the pills out is helpful, without additional information. Medication can be expensive, as they noted.
posted by tiny frying pan at 7:31 AM on October 28, 2023 [13 favorites]
I don't see how telling them to not fish the pills out is helpful, without additional information.
Yeah, for real: why not? Maybe because you should assume the pill caused the nausea, so don't get into an endless vomiting loop and dehydrate yourself? But if it's not the cause of the nausea? For instance an antiemetic presumably wasn't the cause; the nausea preceded the pill and the pill simply didn't have time to dissolve and have its intended effect. So why (other than the obvious problem, namely "EWWWW, Jesus!" that might not be a real doctor-endorsed problem, just bad optics and if nobody but you is witness to the horror and you're not bothered, then save your pill $$) shouldn't you just pluck the medicament from the fray, rinse it off, and swallow it again?
In the icu I work at, patients get their meds re-dosed if they vomit within an hour.
So sounds like yes, take another dose. Obviously it needs to be a fresh new pill at the icu so that the (probably; I dunno) 98% of patients who'd be terminally disgusted by this idea don't sue the hospital for forcing them to re-take their own gently used pills. But what about the brave 2% (or more? or fewer? where is the data?) who truly are not bothered and who are at home and facing this decision unobserved? Still a bad idea?
posted by Don Pepino at 10:30 AM on October 28, 2023 [1 favorite]
Yeah, for real: why not? Maybe because you should assume the pill caused the nausea, so don't get into an endless vomiting loop and dehydrate yourself? But if it's not the cause of the nausea? For instance an antiemetic presumably wasn't the cause; the nausea preceded the pill and the pill simply didn't have time to dissolve and have its intended effect. So why (other than the obvious problem, namely "EWWWW, Jesus!" that might not be a real doctor-endorsed problem, just bad optics and if nobody but you is witness to the horror and you're not bothered, then save your pill $$) shouldn't you just pluck the medicament from the fray, rinse it off, and swallow it again?
In the icu I work at, patients get their meds re-dosed if they vomit within an hour.
So sounds like yes, take another dose. Obviously it needs to be a fresh new pill at the icu so that the (probably; I dunno) 98% of patients who'd be terminally disgusted by this idea don't sue the hospital for forcing them to re-take their own gently used pills. But what about the brave 2% (or more? or fewer? where is the data?) who truly are not bothered and who are at home and facing this decision unobserved? Still a bad idea?
posted by Don Pepino at 10:30 AM on October 28, 2023 [1 favorite]
FYI certain extended release meds have very durable capsules that don’t get digested at all ( people frequently tell me they see them in their stools) so don’t always assume the visible capsule is a sign that nothing got absorbed. Your pharmacist knows best
posted by genmonster at 11:07 AM on October 28, 2023 [8 favorites]
posted by genmonster at 11:07 AM on October 28, 2023 [8 favorites]
Came to mention what genmonster just did—this isn’t really a general question you can crowdsource with such limited info, and a pro really has to answer knowing the particulars.
posted by kapers at 1:10 PM on October 28, 2023 [4 favorites]
posted by kapers at 1:10 PM on October 28, 2023 [4 favorites]
If this pill is an anti-nausea pill and this is a frequent problem you can ask your doctor if they would prescribe suppositories instead. Zofran and its generics are available as suppositories. (As is acetaminophen and a number of other meds). Some patients who cannot take oral meds need an alternative to an oral formulation. Your pharmacy might need to order it in, but if it exists your pharmacy should be able to get it. A good pharmacist can be very helpful with these kinds of questions.
Not an exact answer to your question, but a possible alternative to oral meds if they often make you nauseated.
posted by citygirl at 1:47 PM on October 28, 2023 [1 favorite]
Not an exact answer to your question, but a possible alternative to oral meds if they often make you nauseated.
posted by citygirl at 1:47 PM on October 28, 2023 [1 favorite]
Mod note: Note: I'm leaving the comment, since several people have responded directly to it (it's best to respond to the OP rather than other commenters, partly for this reason), but don't just answer a question like "Tell me about doing/not doing X" with "don't do X." If you don't have the time or inclination to actually give details or info, please just pass on the thread.
posted by taz (staff) at 10:20 PM on October 28, 2023 [2 favorites]
posted by taz (staff) at 10:20 PM on October 28, 2023 [2 favorites]
"Doctors have not been terribly helpful with this question."
Probably not, because you're asking for general guidelines for a wide range of pill types. If you ask a single doctor who prescribes you, say, an ADHD medication and they know all the meds you take - they might be able to give you more info. Like, if you were doing chemo and likely to be nauseous and also taking ADHD meds, they could say "yeah, that's fine," or "it's better to miss a dose."
If you're fishing a pill out (ew) there shouldn't be any risk of overdose and it *might* be effective *if* it hasn't dissolved too much with the active ingredients liquidized but not yet absorbed.
Taking *another* pill is risky, IMO, depending on the nature of the pill. Your doctor should give guidance here.
I've gotten guidance on this for my senior cats, but only around anti-nausea medication and gabapentin. It should be OK to give the pill again for anti-nausea and Gabapentin, but not to give a second dose for anti-nausea (but Gabapentin is very hard to OD on so that's OK).
posted by jzb at 9:19 AM on October 29, 2023
Probably not, because you're asking for general guidelines for a wide range of pill types. If you ask a single doctor who prescribes you, say, an ADHD medication and they know all the meds you take - they might be able to give you more info. Like, if you were doing chemo and likely to be nauseous and also taking ADHD meds, they could say "yeah, that's fine," or "it's better to miss a dose."
If you're fishing a pill out (ew) there shouldn't be any risk of overdose and it *might* be effective *if* it hasn't dissolved too much with the active ingredients liquidized but not yet absorbed.
Taking *another* pill is risky, IMO, depending on the nature of the pill. Your doctor should give guidance here.
I've gotten guidance on this for my senior cats, but only around anti-nausea medication and gabapentin. It should be OK to give the pill again for anti-nausea and Gabapentin, but not to give a second dose for anti-nausea (but Gabapentin is very hard to OD on so that's OK).
posted by jzb at 9:19 AM on October 29, 2023
No, there are no general guidelines, because all medications are different in terms of how long they are expected to take when it comes to the time for their absorption and chemical effect on the body. Even within the class of “ADHD medications” there is no general advice, because the dynamics of a short-acting preparation are so different to a long-acting one.
ICU patients are a very specific population and would have different things going on in their body like decreased gastric motility, so you can’t generalise what an ICU does with their patients to community advice.
posted by chiquitita at 3:30 PM on October 29, 2023
ICU patients are a very specific population and would have different things going on in their body like decreased gastric motility, so you can’t generalise what an ICU does with their patients to community advice.
posted by chiquitita at 3:30 PM on October 29, 2023
Response by poster: Thank you all. It never occurred to me to speak to the pharmacist because mine is ridiculously overworked. For context, the vomiting is cyclical and unrelated to the pills themselves. Today the ER doctor said “if you don’t see it, assume you took it.” I’ve never fished anything out of the vomit but I have wondered quite often. I think I will continue my current approach which is to assume i got the dose ok.
posted by bigbigdog at 5:21 PM on November 2, 2023
posted by bigbigdog at 5:21 PM on November 2, 2023
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posted by mochapickle at 12:45 AM on October 28, 2023 [7 favorites]