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