Antiemetics like prochlorperazine, haloperidol, or ondansetron are often prescribed to alleviate nausea in hospice patients, but there are always situations where symptoms don’t respond, contraindications exist, or medications aren’t readily available. One outside-the-box remedy that hospice clinicians might consider adding to their nausea management toolbox is inhaled isopropyl alcohol vapor.

Some compelling evidence for using inhaled isopropyl alcohol as an intervention for short-term nausea relief comes from studies completed in hospital emergency departments.^1-3 In one study, 120 patients were randomized to receive either inhaled isopropyl alcohol and 4mg of oral ondansetron, inhaled isopropyl alcohol and oral placebo, or inhaled saline solution (placebo) and 4mg of oral ondansetron.³Those treated with inhaled isopropyl alcohol (with or without oral ondansetron) experienced less nausea 30 minutes post administration compared to patients who received placebo and oral ondansetron.³

To date, there aren’t any studies that examine this intervention in hospice patients, but there are case reports of using inhaled isopropyl alcohol to treat nausea in palliative care patients. In a published case series, three palliative care patients were directed to hold a 70% isopropyl alcohol swab 1-2 cm under their nose and then take 2-4 deep inhalations about 2 seconds apart as many times as desired.¹ The origins of nausea for each patient were identified as obstruction due to malignancy, infection, and metabolic causes, respectively.¹ All three patients reported a decrease in nausea after inhaling isopropyl alcohol vapors.¹ Before treatment, the average reported nausea score was 8 out of 10.¹ Afterwards, the average reported nausea score was 2.7 out of 10, with one patient reporting complete resolution.¹Onset of symptom relief ranged from a few minutes up to 30 minutes.¹ Additionally, the authors noted that the effects of isopropyl alcohol inhalation were persistent and efficacy was maintained with subsequent use.¹ No adverse reactions were reported.¹

It’s unknown exactly why inhaling isopropyl alcohol vapors appears to have an anti-nausea effect.¹ One proposed theory is a phenomenon called ‘olfactory distraction’, which has to do with the sense of smell and how it contributes to the experience of nausea.^1,3 Another theory is that the act of sniffing the alcohol swab forces controlled breathing, which may help relieve nausea.^1,3 No matter how inhaled isopropyl alcohol actually works, it’s been shown to help reduce nausea, even in severely ill patients. It seems that a trial of aromatherapy with isopropyl alcohol swabs may be worthwhile for patients with nausea that need symptom relief – they’re cheap, easy to use, readily available, safe, and non-invasive.¹

Written by:

John Corrigan, PharmD

Clinical Pharmacist, OnePoint Patient Care

John’s primary responsibilities as a clinical pharmacist at OnePoint Patient Care are staff and partner education, medication utilization reviews, and assisting with formulary development and maintenance. He attended the University of Iowa for both undergraduate studies and pharmacy school. He earned a PharmD from the University of Iowa College of Pharmacy in 2013. He was first introduced to hospice and OnePoint Patient Care as a 4th year pharmacy student, completing a 5-week elective clinical hospice pharmacy rotation. He started his employment with OnePoint Patient Care as a staff pharmacist in 2014. He transitioned to his current role, as a clinical pharmacist, in the spring of 2019.

References

1. Gabriel De Leon Corona A, Chin J. Olfactory Distraction for Management of Nausea in Palliative Care Patients. American Journal of Hospice & Palliative Medicine. 2022; 39(3):388-393. doi:1177/1049909121015957
2. Haelle T. Alcohol Aromatherapy Relieves Nausea in Short Term. Medscape. December 8, 2015. Accessed February 22, 2022. https://www.medscape.com/viewarticle/855579
3. April M, Oliver J, Davis W, et al. Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. Ann Emerg Med. 2018;72(2):184-193. doi:1016/j.annemergmed.2018.01.016