Antiemetic drugs
Antihistamines / anticholinergics
- Dimenhydrinate
- Hydroxyzine
- Cyclizine
- Meclizine
- Scopolamine
- Trimethobenzamide
Dopamine D₂ receptor antagonists
- Metoclopramide
- Chlorpromazine
- Prochlorperazine
- Promethazine
- Haloperidol
- Droperidol
Serotonin 5‑HT₃ receptor antagonists
- Ondansetron
- Granisetron
- Dolasetron
- Ramosetron
- Tropisetron
Neurokinin‑1 (NK₁) receptor antagonists
- Aprepitant
- Fosaprepitant
- Rolapitant
Others
- Cannabinoids
- Nabilone
- Dronabinol
- Nabiximol
- Dexamethasone
- Netupitant/palonosetron
Pathway to vomiting center
- Opioid analgesics
- Eg. morphine
- Have duality of action
- Dec. emesis by activating receptors that decrease pain transmission
- Inc. emesis by activating receptors in the CTZ.
- Antagonists
- 5HT₃
- D₂
- M₁
- NK₁
- Agonists
- CB₁
Pathophysiology of Emesis
Clinical causes and therapeutic options
Indication | Therapeutic options (scheduling) |
Gastroenteritis | - Dopamine antagonists (S4); - Serotonin antagonists (S4) |
Opioid‑induced nausea and vomiting | - Serotonin antagonists (S4); - Dopamine antagonists (S4) – droperidol |
Migraine‑related nausea and vomiting | Dopamine antagonists (S4) - Metoclopramide with paracetamol (S3); - Metoclopramide (S4); - Prochlorperazine (S3 or S4) |
Vestibular causes of nausea and vomiting | - Antihistamines (S3); - Anticholinergics (S3); - Dopamine antagonists (S4) |
Chemotherapy‑induced nausea and vomiting | - Serotonin antagonists (S4); - Neurokinin‑1 antagonists (S4); - Corticosteroids (S4) – dexamethasone; - Dopamine antagonists (S4) – olanzapine, haloperidol; - Benzodiazepines (S4) – lorazepam |
Radiation‑induced nausea and vomiting | - Serotonin antagonists (S4); - Corticosteroids (S4) – dexamethasone; - Dopamine antagonists (S4) |
Postoperative nausea and vomiting | - Dopamine antagonists (S4); - Serotonin antagonists (S4); - Antihistamines (S3); - Corticosteroids (S4) – dexamethasone; - Neurokinin‑1 antagonists (S4); - Benzodiazepines (S4) – lorazepam |
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