14.01.22 Antiemetics

Antihistamines (H1 histamine receptor antagonists)

• Indications

  • Motion sickness, morning sickness, opioid nausea

• Side effects

• Examples

  • Cyclizine

  • Diphenhydramine (Benadryl)

  • Dimenhydrinate

  • Doxylamine

  • Meclozine

  • Promethazine

  • Hydroxyzine

Dopamine antagonists

• Indications

  • Neoplastic disease, radiation sickness, opioids, cytotoxic drugs, general anaesthetics

• Side effects include

  • Muscle spasms, restlessness

  • Examples

  • Domperidone

  • Olanzapine

  • Droperidol

  • Haloperidol

  • Chlorpromazine

  • Promethazine

  • Prochlorperazine (Stemetil)

  • Alizapride

  • Metoclopramide

5-HT3 receptor antagonists

• Indications

  • Post-operative and cytotoxic drug nausea & vomiting

• Side effects

  • Constipation or diarrhea, dry mouth, fatigue

  • Examples

  • Ondansetron

  • Dolasetron

  • Granisetron

  • Tropisetron

  • Palonosetron

  • Mirtazapine

Anticholinergics

• Examples

  • Hyoscine

Steroids

• Indications

  • General anaesthetic

• Examples

  • Dexamethasone

Cannabinoids

• Indications

  • Cachexia, cytotoxic nausea/vomiting, unresponsive to other agents

  • Side effects

  • Changes in perception, dizziness, and loss of coordination

• Examples

  • Cannabis

  • Dronabinol

  • Synthetic cannabinoids - Nabilone (Cesamet), JWH series

  • Sativex

Benzodiazepines

• • Indications

    • General anaesthetic

  • Examples

  • Midazolam

  • Lorazepam

Neurokinin 1 receptor antagonist

• • Indications

    • Chemotherapy, esp. delayed emesis

• Examples

  • Aprepitant

Other

• Trimethobenzamide

  • Thought to work on the CTZ

• Ginger

  • Contains 5HT3 antagonists gingerols and shogaols

• Emetrol

• Propofol

• Peppermint

• Muscimol

• Ajwain