Vomiting is the forceful, projectile emptying of the stomach contents outwards through the oesophagus. Behind it lies a finely tuned protective reflex controlled by the vomiting centre in the brain: the abdominal and diaphragm muscles contract powerfully and force the stomach contents upwards. Vomiting is usually heralded by nausea, increased salivation, pallor and sweating.
The reflex serves a useful purpose: it is meant to protect the body from harmful or toxic substances. That is why vomiting is not a disease in its own right, but a symptom — a warning and protective sign that can have many different causes. In the vast majority of cases, something harmless and temporary lies behind it.
The most important thing first
A single episode or brief vomiting is usually harmless and passes on its own. Two things are decisive: whether warning signs such as blood or severe headache or abdominal pain accompany it — and whether the vomiting means you take in too little fluid or lose important medications.
2. Harmless or dangerous?
The key question is not simply "do I have to vomit?", but "how often, how long and what else is there?". Two situations should be kept apart:
Brief, one-off vomiting with good general health: usually harmless. Typical with a gastrointestinal infection, after spoiled food or too much alcohol. If you can drink in between and recover slowly, a visit to the doctor is usually not necessary.
Persistent, repeated vomiting: can lead to a dangerous loss of fluid and salt — especially in children, older people and in combination with diarrhoea. Then it is about counteracting it in good time.
Vomiting often occurs together with nausea — nausea is effectively the precursor. Vomiting becomes dangerous above all when blood is mixed in, when the most severe headache or severe abdominal pain accompanies it, or when signs of serious dehydration appear (more on this in the chapter "When to see a doctor").
3. Causes & triggers
Vomiting has very many possible causes — the vast majority are harmless and temporary. Often the trigger can be worked out easily from the situation.
Gastrointestinal infections: viruses (e.g. noroviruses or rotaviruses) and bacteria are the most common reason, often together with diarrhoea.
Spoiled food and alcohol: food poisoning or too much alcohol strongly irritate the stomach.
Travel and motion sickness: conflicting sensory signals in a car, bus, ship or aeroplane.
Migraine: with a migraine, nausea and vomiting are often part of the attack.
Medication: some active substances (such as certain painkillers, antibiotics or chemotherapy) can trigger vomiting.
Pregnancy: especially in the first months, morning sickness with vomiting is common.
More serious causes: rarer, but important — e.g. inflammation of the stomach lining, appendicitis, a bowel obstruction or disorders of the brain and inner ear.
The link with a particular meal, a journey or a new medication in particular can often be recognised yourself. A short log — what, when, how often — helps to uncover patterns and to give the doctor the right clues.
4. Drinking correctly: the rehydration plan
The most important thing with vomiting is to make up for the loss of fluid and salt. Anyone who drinks a large glass straight after vomiting often provokes the next bout of vomiting. The trick is therefore: sip by sip, but regularly.
Wait a little: after vomiting, give your stomach about 30 to 60 minutes' rest before you drink again.
Start small: every few minutes, slowly drink one to two teaspoons or a small sip — about 5 to 10 ml.
Build up: if it stays down, carefully increase the amount over the hours until you are drinking normally again.
Drink the right thing: still water, unsweetened tea or an electrolyte solution from the pharmacy. With a lot of loss, an oral rehydration solution replaces salts and sugar in the right ratio.
Very sweet, very cold or carbonated drinks irritate the stomach further and are rather unfavourable. If diarrhoea is added to the vomiting, the fluid requirement rises considerably — then an electrolyte solution is particularly sensible.
Keep an eye on your intake and progress
With brite you document when you vomited, what you drank and how you feel — the best basis for spotting dehydration early.
This question arises for many people and is rarely answered clearly: if I vomit, does the pill still work — and do I need to re-dose tablets? The reason for the uncertainty is simple: the active ingredient of a swallowed tablet needs time to be absorbed by the stomach and intestine. Anyone who vomits too early may lose it before it could take effect.
As a rule of thumb: if you vomit within about 2 to 4 hours of taking it, the active ingredient is often not yet fully absorbed — the tablet is then considered "lost" and should as a rule be re-dosed.
Situation
What to do
Vomiting < 2–4 hrs after taking
Active ingredient possibly lost — re-dose after consulting a professional/the package leaflet
Vomiting > 3–4 hrs after taking
Active ingredient usually absorbed — no re-dosing needed as a rule
Contraceptive pill vomited
Treat like a missed pill (package leaflet); if unsure, use additional contraception
Repeated vomiting over hours
Absorption uncertain — ask a doctor or pharmacy
Table scrollable to the right
Specifically about the contraceptive pill
If you vomit within about 3 to 4 hours of taking the pill, contraceptive protection may not be reliable. In that case, proceed as with a missed pill: check the package leaflet, take the next pill if necessary and, with vomiting persisting over several days, additionally use a condom. The exact rules are in the package insert of your preparation.
For other important medications — such as blood pressure, thyroid or pain medication — the same applies accordingly. However, do not simply take a double dose, but ask at the pharmacy or doctor's practice when in doubt. An active ingredient such as Metoclopramide can be prescribed by a doctor for severe vomiting to dampen the urge to vomit.
6. When to see a doctor?
Vomiting is usually harmless, but there are clear situations in which you should have it checked or act immediately.
You should have it checked by a doctor promptly if the vomiting lasts longer than one to two days, keeps coming back, you cannot keep anything down, high fever is added or you notice signs of beginning dehydration (strong thirst, dry mouth, dark and scanty urine, weakness). Early medical advice is also sensible for infants, small children, older or chronically ill people.
Call the emergency number 112 immediately
With vomiting blood (red blood or coffee-ground-like, dark vomit), with vomiting accompanied by the most severe headache or a stiff neck, after a head injury, together with severe abdominal pain or with signs of serious dehydration (drowsiness, hardly any urine, sunken eyes). These combinations can point to an emergency.
7. What you can do yourself
Drink in sips: in small amounts and regularly, ideally water, unsweetened tea or an electrolyte solution (see rehydration plan).
Give it rest: give your stomach time and do not eat straight away. When you feel better, start with light food such as rusks, pretzel sticks, banana or clear broth.
Avoid triggers: leave out fatty, very sweet or heavily spiced food, alcohol, coffee and nicotine for now.
Check medications: consider whether you vomited shortly after taking them and whether you need to re-dose (see chapter "Does the pill still work?").
Keep a log: when, how often and in what context does the vomiting occur? This helps you and the practice to find the cause.
Forget nothing important — even when you feel unwell
brite reminds you of doses and records your progress, so that with vomiting you immediately know what to do — free of charge and ad-free.
When you feel sick, the last thing you want is to also remember when you last drank or took your tablet. brite keeps track of that for you — from your fluid intake to the question of whether you need to re-dose.
Health history — document vomiting, nausea, fluid intake and possible triggers (food, travel, medication) over time and bring it as an overview to your appointment. Track your history
Dose reminder — brite logs when you took the pill & co. That way you can see straight away whether you vomited shortly after taking it and need to re-dose. Set up a reminder
Interaction check — checks whether one of your medications favours nausea and vomiting as a side effect. Check now
Digital medication plan — all your medications clearly in one place, so you keep an overview even when you are ill. Go to the medication plan
If you vomit within about 3 to 4 hours of taking the pill, contraceptive protection may not be reliable, because the active ingredient was not yet fully absorbed. In that case, proceed as with a missed pill according to the package leaflet and, with persistent vomiting, additionally use a condom.
As a rule of thumb: if you vomit within about 2 to 4 hours of taking it, the active ingredient was often not yet absorbed and the dose should be re-taken. After more than 3 to 4 hours, re-dosing is usually not needed. When in doubt, do not take a double dose, but ask at the pharmacy or doctor's practice.
Drink in sips rather than in large amounts: after vomiting, give your stomach about 30 to 60 minutes' rest, then every few minutes one to two teaspoons of still water, unsweetened tea or an electrolyte solution. If it stays down, slowly increase the amount. This way you avoid triggering the next bout of vomiting.
Wait until the nausea eases, then begin with light, low-fat food such as rusks, pretzel sticks, banana, rice or clear broth. Eat small portions and build up slowly. You should avoid fatty, very sweet or heavily spiced food, alcohol and coffee at first.
Usually rest, fresh air, sipping fluids and going without solid food until the stomach settles already helps. With severe or persistent vomiting, the doctor can prescribe a medication against nausea such as Metoclopramide. Only take such remedies after consultation and not on your own initiative in a high dose.
Call the emergency number 112 immediately with vomiting blood (red or coffee-ground-like), with vomiting accompanied by the most severe headache or a stiff neck, after a head injury, together with severe abdominal pain or with signs of serious dehydration such as drowsiness and hardly any urine. These combinations can point to an emergency.
Signs of fluid deficiency are strong thirst, dry mouth, scanty and dark urine, weakness, dizziness and sunken eyes. In children and older people, dehydration can quickly become dangerous. Make up for the loss with an electrolyte solution and seek medical help with clear signs.
Brief vomiting with a gastrointestinal infection usually settles on its own within one to two days. Consult a doctor if it lasts longer, keeps coming back, you cannot keep anything down, high fever is added or you notice signs of dehydration. For small children and older people, sooner.
Yes. With a migraine, nausea and vomiting are often part of the attack. If you vomit shortly after taking your migraine or other medication, it can become ineffective. Talk to the practice about active ingredients that are reliably absorbed even with nausea, for example as an orodispersible tablet, suppository or injection.
German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). dgvs.de
Prescribing information for hormonal contraception: what to do with vomiting and diarrhoea (package leaflet of the respective preparation).
This article is for general information and does not replace medical advice, diagnosis or treatment. With vomiting blood, vomiting accompanied by the most severe headache, after a head injury, with severe abdominal pain or signs of serious dehydration, please call the emergency number 112 without delay.
