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Types of antiemetics
- 5-HT3 receptor antagonists block serotonin receptors in the central nervous system and gastrointestinal tract. As such, they can be used to treat post-operative and cytotoxic drug nausea & vomiting. However, they can also cause constipation or diarrhea, dry mouth, and fatigue.
- Dolasetron (Anzemet) can be administered in tablet form or in an injection.
- Granisetron (Kytril, Sancuso) can be administered in tablet (Kytril), oral solution (Kytril), injection D(Kytril), or in a single transdermal patch to the upper arm (SANCUSO).
- Ondansetron (Zofran) is administered in an oral tablet form, orally dissolving tablet form, orally dissolving film, or in an IV/IM injection.
- Tropisetron (Setrovel, Navoban) can be administered in oral capsules or in injection form.
- Palonosetron (Aloxi) can be administered in an injection or in oral capsules.
- Mirtazapine (Remeron) is an antidepressant that also has antiemetic effects and is also a potent histamine H1 receptor antagonist, Ki=1.6 nM.
- Dopamine antagonists act in the brain and are used to treat nausea and vomiting associated with neoplastic disease, radiation sickness, opioids, cytotoxic drugs and general anaesthetics. Side effects include muscle spasms and restlessness.
- Domperidone (Motilium)
- Olanzapine (Zyprexa)
- Droperidol, haloperidol, chlorpromazine, prochlorperazine. Some of these drugs are limited in their usefulness by their extra-pyramidal and sedative side-effects.
- Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil)
- Metoclopramide (Reglan) also acts on the GI tract as a pro-kinetic, and is thus useful in gastrointestinal disease; however, it is poor in cytotoxic or post-op vomiting. also a 5-HT3 receptor antagonists
- NK1 receptor antagonist
- Antihistamines (H1 histamine receptor antagonists) are effective in many conditions, including motion sickness, morning sickness in pregnancy, and to combat opioid nausea.
- Cannabinoids are used in patients with cachexia, cytotoxic nausea, and vomiting, or who are unresponsive to other agents. These may cause changes in perception, dizziness, and loss of coordination.
- Cannabis, also known as medical marijuana in the United States, is a Schedule I drug.
- Dronabinol (Marinol) is a Schedule III drug in the U.S.
- Some synthetic cannabinoids such as Nabilone (Cesamet) or the JWH series.
- Sativex is an oral spray containing THC and CBD. It is currently legal in Canada and a few countries in Europe but not legal in the U.S.
- Trimethobenzamide is thought to work on the CTZ
- Ginger contains 5-HT3 antagonists gingerols, shogaols, and galanolactone.
- Emetrol is also claimed to be an effective antiemetic.
- Propofol is given intravenously. It has been used in an acute care setting in hospital as a rescue therapy for emesis.
- Peppermint is claimed to help nausea or stomach pain when added into a tea or peppermint candies.
- Muscimol is purported to have antiemetic activity.
- Ajwain is purported to be antiemetic. It is a popular spice in India, Ethiopia and Eritrea.
- Zachary A. Flake, Robert D. Scalley, Austin G. Bailey (Mar 1, 2004), "Practical Selection of Antiemetics", Am Fam Physician 69 (5): 1169–1174
- Pae C-U. Low-dose mirtazapine may be successful treatment option for severe nausea and vomiting. Progress in Neuro-Psychopharmacology and Biological Psychiatry [Internet]. 2006 Aug 30 [cited 2013 Sep 27];30(6):1143–5. Available from: http://www.sciencedirect.com/science/article/pii/S0278584606000935
- Kast R e., Foley K f. Cancer chemotherapy and cachexia: mirtazapine and olanzapine are 5-HT3 antagonists with good antinausea effects. European Journal of Cancer Care [Internet]. 2007 [cited 2013 Sep 27];16(4):351–4. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2354.2006.00760.x/abstract
- National Institute of Mental Health. PDSD Ki Database (Internet) [cited 2013 Sep 27]. Chapel Hill (NC): University of North Carolina. 1998-2013. Available from: http://pdsp.med.unc.edu/pdsp.php
- Abdel-Aziz H, Windeck T, Ploch M, Verspohl EJ. (2006-01-13), "Mode of action of gingerols and shogaols on 5-HT3 receptors: binding studies, cation uptake by the receptor channel and contraction of isolated guinea-pig ileum.", Eur J Pharmacol. 530 (1-2): 136–43, PMID 16364290 Epub 2005 Dec 20
- Huang, Q.; Iwamoto, Y.; Aoki, S.; Tanaka, N.; Tajima, K.; Yamahara, J.; Takaishi, Y.; Yoshida, M.; Tomimatsu, T.; Tamai, Y. (1991). "Anti-5-hydroxytryptamine3 effect of galanolactone, diterpenoid isolated from ginger". Chemical & pharmaceutical bulletin 39 (2): 397–399. doi:10.1248/cpb.39.397. PMID 2054863.
- hoe 2#section1 Muscimol. Chemical Data Sheet, Database of Hazardous Materials, CAMEO chemicals