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Gravol Admin in the Elderly

Question# 737

Reading up on RPPEO Medic News from May 2023,

Like a “double negative”, having some issues with the news of:

MA-2023-02 Dimenhydrinate for Patients 65 or Older was rescinded on April 12 2023…..This memo supersedes the RPPEO guidance, therefore we have rescinded MA-2023-02…

Are we giving Gravol to over 65 nor not..??

Have re-read several times and this is still not clear to me…


We’ve heard your frustration as you try to follow the Standards in the face of sometimes conflicting information. Dr. Austin will be speaking to this in Fall CME 2023.

The addition of ondansetron to the Patient Care Standards to treat nausea and vomiting was meant as a safer alternative to dimenhydrinate - Gravol - in older patients.

But the rollout of ondansetron has been complicated by supply shortages and confusion about how best to treat patients 65 and older with nausea and vomiting.

Evidence shows that older adults are at risk for increased anticholinergic effects such as somnolence, confusion, delirium, and urinary retention with medications like dimenhydrinate. This is because chronic disease processes can affect drug metabolism.

Another complicating factor is that older people are sometimes on complex pharmaceutical regimes. Many medications interact with dimenhydrinate and may worsen its adverse effects. For these reasons, ondansetron is going to be the safest antiemetic for your older patients in most cases.

In motion sickness, remember that ondansetron has little effect. You’ll want to look to dimenhydrinate for nausea or vomiting caused by inner ear imbalances during motion and weigh the risk benefit of the potential adverse effects.

For a patient who’s 65 or older, you need to patch if you’re considering dimenhydrinate. The Patient Care Standards do not provide standing orders for dimenhydrinate in patients 65 or older unless ondansetron is not available. So, by calling a base hospital physician you can discuss the appropriateness and risks of dimenhydrinate for these patients.

The therapeutic dose of dimenhydrinate is 25 to 50 milligrams. For the older patient, be sure to consider an initial lower dose. 25 mg of dimenhydrinate is often a safer option that still offers the therapeutic benefits with less potential for adverse effects. You can always give more, but you can’t take away what you’ve already given.


ALS PCS - Nausea/Vomiting Medical Directive

Medical Directive Category



13 October 2023



Please reference the MOST RECENT ALS PCS for updates and changes to these directives.