If your doctor won't prescribe standard antiemetics, there are limited but still potentially useful otc alternatives, though none are quite as reliable as prescription options.
For the amitriptyline method, controlling vomiting is important but slightly less critical than with SN, since tricyclic antidepressants are absorbed relatively quickly in the small intestine. However, vomiting before absorption can still result in failed or partial attempts, so having some form of antiemetic support is wise.
Some alternatives include:
- Diphenhydramine (Benadryl if you're American): An antihistamine with mild anti nausea properties. It also causes sedation, which can be helpful alongside amitriptyline. However, it's not specifically targeted for vomiting and can cause anticholinergic side effects, which may interact with amitriptyline, so dosing must be conservative.
- Meclizine or cyclizine: These are motion sickness medications with mild antiemetic effects, available over the counter in some regions. Like diphenhydramine, they aren't as effective but may help blunt nausea.
- Promethazine: If you can obtain it without a prescription, it's one of the stronger OTC adjacent antihistamines with proper antiemetic effects. It's used in hospitals for nausea and may be effective in moderate doses, but carries sedative effects and anticholinergic risks as well.
Avoid stacking multiple sedating or anticholinergic medications unless you're confident of the interactions. Amitriptyline is already cardiotoxic and CNS depressing, so adding anything that prolongs QT interval or increases CNS suppression can increase risks of complications, not certainty.
If access is too limited, you may also want to consider a 12–15 hour fast and consuming the dose on a nearly empty stomach with minimal water, which may reduce the likelihood of vomiting altogether. Some people using the amitriptyline method have succeeded without antiemetics, but the risk of vomiting still exists, especially in high doses.
