Cyclic Vomiting Syndrome Home Action Plan

Green Zone Signs/Symptoms Treatment

Happy & Healthy No triggers

None, some mild nausea

Prophylactic medications: 1. Mirtazapine 15 mg PO QHS 2. Gabapentin 300/300/600 (am, noon, HS) - need to titrate up to this dose 3. Consider adding amitryptiline 100mg PO QHS - need to titrate up to this dose Supplements a. L-carnitine 1 gram PO BID b. CoQ10 200 mg PO BID c. Vitamin B2 100 mg PO QD

Note: List typical triggers here:

Yellow Zone Signs/Symptoms Treatment

Triggers present Early typical symptoms of an acute episode

Increasing nausea Decreasing food tolerance Abdominal discomfort Mood instability

Supportive medications: 1. Increase mirtazapine to 30 mg PO QHS And add… 2. Ondansetron 8 mg SL Q8H 3. Diphenhydramine 25 mg PO Q8H 4. Ketorolac 10 mg PO Q8H

Note: Contact PCP to consider MHP evaluation or visit to NTR Red Zone Signs/Symptoms Treatment

Acute exacerbation Active vomiting Continuous nausea

At onset of Red Zone symptoms 1. Warm shower or bath 2. Quiet, dark room 3. Frequent small sips of fluid 4. Sumatriptan 20mg nasal spray, repeat in 2H 5. Diphenhydramine 50 mg PO Q8H

If ineffective after 1-2 hours, call nurse advice line or go to ER