# Acute Vomiting (adult, non-surgical) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Clinical Knowledge Summaries: Nausea and vomiting 2021 · Egyptian National Drug Formulary 2026 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph) ## Treatment metadata - Ondansetron — 4 mg — oral.solid - Metoclopramide — 10 mg — oral.solid - Granisetron — 1 mg — oral.solid ## Complete treatment card ```text ACUTE VOMITING (ADULT, NON-SURGICAL) Sources: NICE Clinical Knowledge Summaries: Nausea and vomiting 2021 · Egyptian National Drug Formulary 2026 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph) Review status: REVIEWED against the source listed above (2026-08) 1. ONDANSETRON [1st line] Adult 4-8 mg orally (or 4-8 mg slow IV/IM) every 8 hours PRN for severe acute non-surgical vomiting x 1-3 days PRN Peds Not routinely indicated for mild childhood vomiting; in acute gastroenteritis with dehydration, single oral dose (0.15 mg/kg, max 8 mg) may be given under clinical supervision Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (ondansetron monograph) Why Effective 5-HT3 receptor antagonist available in Egypt (Danofran, Danset); used off- label in primary care for acute gastroenteritis vomiting as an alternative to dopamine antagonists. Caution Surgical causes of acute abdomen (appendicitis, bowel obstruction, acute cholecystitis) MUST be excluded before administering antiemetics. May prolong QT interval; exercise caution in patients with long QT syndrome, electrolyte disturbances, or concomitant QT-prolonging drugs. Common side effects include headache, flushing, and constipation. The formulary's ondansetron dosing covers chemotherapy and radiotherapy nausea, where the adult dose is 8 mg. Use for acute non-surgical vomiting is not a licensed indication in the formulary. Contraindicated in hypersensitivity to ondansetron or any component of the formulation, and in concomitant use with apomorphine. Egypt DANOFRAN 4MG 5 F.C. TAB. UP PHARMA 70.00 EGP (14.00/unit) SETRONOMET 4 MG 4 ORAL DIS. TABS. AVERROES PHARMA 78.00 EGP IDIVOMTRON 4 MG 10 ORALLY DIS. TABS. INTERNATIONAL DRUG AGENCY (IDI) 144.00 EGP EMEREST 4 MG 10 ORO-DISPERSIBLE TABS. GLOBAL PHARMACEUTICAL INDUSTRIES 188.00 EGP IDIVOMTRON 4 MG/5ML SYRUP 50 ML RAMEDA > INTE... 110.00 EGP -> ? strength differs, ? different route - not oral solid 2. METOCLOPRAMIDE [2nd line] Adult 10 mg orally (or IM/IV) up to three times daily (max 30 mg/day or 0.5 mg/kg/day) - Up to 5 days max Peds 1 to 18 years: Second line only: 0.1 to 0.15 mg/kg by mouth, IM or IV, repeated up to three times daily (Pediatric patients aged 1-18 years Nausea and vomiting indications (as a second-line agent) • Oral, IM, IV: 0.1 to 0.15 mg/kg, repeated up to three times daily.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) Why Prokinetic dopamine D2 antagonist registered in Egypt (Meclopram, Clopram) for acute nausea and vomiting of gastrointestinal origin Caution There is a high risk of extrapyramidal side effects (acute dystonic reactions, oculogyric crisis), especially in young adults and females; strictly limit duration to max 5 days. Contraindicated in mechanical gastrointestinal obstruction, perforation, or phaeochromocytoma. Reduce dose in renal or hepatic impairment. Contraindicated in epilepsy, in Parkinson's disease, and in combination with levodopa or a dopaminergic agonist. Egypt CLOPRAM 10MG 20 TAB. EL NASR 3.00 EGP (0.15/unit) PLEMAZOL 10MG 20 TAB. CID 3.20 EGP (0.16/unit) VOMAWAY 10MG 20 TAB. MEMPHIS 8.50 EGP (0.42/unit) PRIMPERAN 10MG 10 SCORED TAB. SANOFI 10.50 EGP 3. GRANISETRON [3rd line] Adult 1 mg twice daily or 2 mg once daily by mouth; the first dose is taken 1 hour before the emetogenic stimulus - Up to one week Peds The formulary gives paediatric dosing only for the intravenous route (10-40 micrograms/kg, up to 3 mg, in children 2 years and over) and only for chemotherapy or radiotherapy nausea. There is no oral paediatric dose - do not extrapolate one. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (granisetron monograph) Why 15 live products. A 5-HT3 antagonist alternative for a patient who has not responded to or cannot take ondansetron; the oral tablet and 1 mg/5 mL solution are both on the Egyptian market. Caution The licensed indications are chemotherapy-induced, radiotherapy-induced and post- operative nausea - use in undifferentiated acute vomiting is outside the licence. Ondansetron is already in this condition, is cheaper, and has far more evidence in general acute vomiting - granisetron is a second choice, not an upgrade. Do not use an antiemetic to mask an undiagnosed surgical abdomen; examine first. Class QT prolongation - avoid in a patient already on another QT-prolonging drug. Stop for serotonin syndrome (agitation, clonus, hyperreflexia, fever), particularly in a patient on an SSRI or SNRI. Avoid combination with Apomorphine (Risk X interaction). The maximum is 9 mg in 24 hours by any route. Egypt EMETOVOID 1 MG 10 F.C.TABS. SEDICO 72.00 EGP (7.20/unit) EM-EX 1 MG 10 F.C.TABS. AMOUN 200.00 EGP (20.00/unit) GRANITRYL 1 MG 5 F.C.TABS. INTERNATIONAL... 202.00 EGP (40.40/unit) GRANITRYL 1MG/5ML ORAL SOLUTION 30 ML DELTA GRAND > EGYPHARMA-EGYPT 226.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)