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How to Treat Bilious Vomiting Syndrome in Cats

By Jennifer Coates, DVM



If your cat has been diagnosed with bilious vomiting syndrome, this is what you can expect to happen next.


  • Diet: The most common form of treatment for bilious vomiting syndrome is to increase the frequency of feedings or to leave food out all of the time.
  • Medication: If more frequent feedings do not resolve the problem, medications (e.g., famotidine, omeprazole, metoclopramide, or maropitant) may be prescribed.


What to Expect at the Vet’s Office


Your veterinarian will take a complete history and perform a physical examination to determine the cause of your cat’s vomiting. If they are not completely convinced that bilious vomiting syndrome is the only possible cause, they might run some diagnostic tests to rule out some of the other causes of chronic vomiting in cats. Possibilities include:


  • Fecal examinations
  • Bloodwork
  • Urinalysis
  • Abdominal X-rays and/or ultrasound
  • Endoscopy of the gastrointestinal tract with biopsies
  • Exploratory surgery with biopsies


What to Expect at Home


The classic symptom of bilious vomiting syndrome is vomiting on an empty stomach. This often occurs first thing in the morning since many cats don’t eat throughout the night. Because the cat’s stomach is empty, all that comes up is fluid, mucus, and often some bile, which may tinge everything an orangey-brown color. Cats with bilious vomiting syndrome have no other gastrointestinal symptoms (diarrhea, weight loss, poor appetite, etc.).


Most cats with bilious vomiting syndrome respond well to more frequent feedings. If the vomiting typically occurs in the morning, feed a meal right before bedtime and then first thing in the morning. As long as weight gain is not a concern, leaving food out all day and night long is a good option. An automatic feeder can also be used to offer small, measured meals at regular intervals throughout the day and night. Some veterinarians also recommend switching cats to a high protein diet, ideally canned, as part of the treatment for bilious vomiting syndrome.


When a cat who is suspected of having bilious vomiting syndrome doesn’t get better after eating more frequent meals and other causes of chronic vomiting have been ruled out, medications can be added to the treatment plan. Some cats respond to drugs that reduce gastric acidity, like famotidine or omeprazole, while others do better with metoclopramide, a medication that increases the frequency of contractions within the small intestines, or maropitant, a broad spectrum anti-vomiting drug.


Questions to Ask Your Vet


Ask your veterinarian what the possible side effects are of any medications your cat is taking. Find out when they next want to see your cat for a progress check and what you should do if your cat’s condition doesn’t improve with the initial treatment plan.


Possible Complications to Watch For


Talk to your veterinarian if you have any questions or concerns about your cat’s condition.


  • Some cats who take medications can develop side effects, such as loss of appetite, vomiting, diarrhea, unusual behavior, etc. Make sure you understand what your cat’s reaction to any prescribed medications should be.



Image: Komar / Shuttestock