Pharm
Antiemetic
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Antiemetic
, Anti-emetic, Phenothiazine Antiemetic, Benzamide Antiemetic
See Also
Nausea
Nausea Causes
Nausea After Surgery
Nausea in Cancer
Nausea in HIV
Nausea in Pregnancy
Antiemetic in Pregnancy
Medication Induced Vomiting
Mechanism
Nausea
and
Vomiting
is mediated via the physiologic
Vomiting
center in the
Medulla
Stimulation of
Vomiting
center via three pathways
Vestibular fibers (e.g.
Vertigo
)
Afferent visceral fibers (e.g. gastrointestinal)
Fourth Ventricle
(Chemoreceptor
Trigger Zone
)
Preparations
5-HT3 Receptor Antagonist
Indications
Preferred first-line Antiemetic in U.S. in most cases
Severe
Nausea
and
Vomiting
Chemotherapy
-Induced (See
Nausea in Cancer
)
Agents
Ondansetron
(
Zofran
)
Granisetron
(
Kytril
)
Dolasetron
(
Anzemet
)
Palonosetron
(
Aloxi
)
Adverse effects
Asthenia
Dizziness
Constipation
QT Prolongation
(see
Ondansetron
)
Serotonin Syndrome
Use in pregnancy may be associated with increased risk of
Congenital Heart Defect
and
Cleft Palate
(2014) Presc Lett 21(1): 5
Preparations
Phenothiazines
Indications
Migraine Headache
s
Motion Sickness
or
Vertigo
Chemotherapy
-Induced (See
Nausea in Cancer
)
Postoperative
Nausea
(See
Nausea After Surgery
)
Severe
Nausea
and
Vomiting
Agents
Prochlorperazine
(
Compazine
)
Promethazine
(
Phenergan
)
Adverse effects
Extrapyramidal Side Effect
s (e.g.
Dystonic Reaction
)
Preparations
Substituted benzamides
Indications
Diabetic Gastroparesis
Migraine Headache
s
Agents
Metoclopramide (Reglan)
Trimethobenzamide
(
Tigan
)
Adverse effects
Extrapyramidal Side Effect
s
Preparations
Butyrophenones
Agents
Droperidol
(
Inapsine
)
Use limited due to potential for
Prolonged QT
Gene
rally unavailable in U.S. since 2012
Haloperidol
(
Haldol
)
Indications
Chemotherapy
-Induced (See
Nausea in Cancer
)
Postoperative
Nausea
(See
Nausea After Surgery
)
Adverse Effects
Sedation
Agitation
or restlessness
Preparations
Antihistamine
s
Agents
Dimenhydrinate (Dramamine)
Meclizine (Antivert)
Scopolamine (Transdermal)
Indications
Vertigo
Motion Sickness
Adverse Effects (
Anticholinergic
effects)
Sedation
Constipation
Dry Mouth
Urinary Retention
Preparations
Adjunctive and atypical Antiemetics
Dexamethasone
Chemotherapy
-Induced (See
Nausea in Cancer
)
Cannabinoids (
Dronabinol
)
Chemotherapy
-Induced (See
Nausea in Cancer
)
Benzodiazepine
s (
Lorazepam
,
Diazepam
,
Clonazepam
)
Chemotherapy
-Induced (See
Nausea in Cancer
)
Not generally recommended
Preparations
Brief list of some options for Adults
Prochlorperazine
(
Compazine
)
Other Routes: 5-10 mg PO/IM/IV every 6-8 hours prn
Rectal: 25 mg PR g12h
Metoclopramide (Reglan)
Dose: 10 mg PO/IM/IV every 6 hours prn or 1 hour before meals and qhs
Promethazine
(
Phenergan
)
Dose: 12.5 mg IV or 25 mg PO/IM/PR q4-6h
Ondansetron
(
Zofran
)
Dose: 4 mg (0.15mg/kg) IV (or PO) over 15 min q4h prn
References
Flake (2015) Am Fam Physician 91(5): 293-6 [PubMed]
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