Relation of Dose and Type of Estrogen to Nausea and Vomiting

Abstract

THERE IS A WIDE DIVERGENCE of opinion both as to the incidence and the cause of nausea and vomiting following the administration of stilbestrol. The incidence of reactions has varied widely in reports by different authors, some reporting an incidence as low as 5%, others as high as 80%. The various methods claimed to diminish or obviate these reactions, such as administering the substance in powdered form in milk, in enteric coated pills, in gelatin capsules or with bile acids, do not seem logical. Since nausea and vomiting are also produced by parental administration, of stilbestrol it is unlikely that such reactions are caused by a local effect in the gastrointestinal tract. We have also observed such reactions in a few patients given the substance by inunction. A detailed review of the many reports on stilbestrol is beyond the scope of this article. There is, however, a fairly good correlation between the size of the dosages used by the various authors and the incidence of reactions which they have reported. In general, the authors who have used the higher doses have obtained a higher incidence than those who have used lower dosages. Shorr, Robinson and Papanicolaou (1), however, concluded that “there is no relation between the size of the dose and the development of toxic reactions.” More recently Mazer, Israel and Ravetz (2) presented evidence that there is a definite relationship between the size of the dose and the incidence of reaction.