Antiemetic

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Types of Antiemetics

• 5-HT₃ receptor antagonists
  5-HT3 antagonist
  
  The 5-HT3 antagonists are a class of medications which act as receptor antagonists at the 5-HT3 receptor , a subtype of serotonin 5-HT receptor found in terminals of the vagus nerve and in certain areas of the brain....
   - these block serotonin
  Serotonin
  
  Serotonin is a monoamine neurotransmitter synthesized in serotonergic neurons in the central nervous system and enterochromaffin cells in the gastrointestinal tract of animals including humans....
   receptors in the central nervous system
  Central nervous system
  
  The central nervous system is the part of the nervous system that functions to coordinate the activity of all parts of the bodies of multicellular organisms....
   and gastrointestinal tract
  Gastrointestinal tract
  
  The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
  . As such, they can be used to treat post-operative and cytotoxic drug nausea & vomiting.
• Dolasetron
  Dolasetron
  
  Dolasetron is a serotonin 5-HT3 antagonist used to treat nausea and vomiting following chemotherapy. Its main effect is to reduce the activity of the vagus nerve, which is a nerve that activates the vomiting center in the medulla oblongata....
   (Anzemet)
• Granisetron
  Granisetron
  
  Granisetron is a serotonin 5-HT3 antagonist used as an antiemetic to treat nausea and vomiting following chemotherapy. Its main effect is to reduce the activity of the vagus nerve, which is a nerve that activates the vomiting center in the medulla oblongata....
   (Kytril, Sancuso)
• Ondansetron
  Ondansetron
  
  Ondansetron or GlaxoSmithKline's Zofran is a serotonin 5-HT3 antagonist used mainly as an antiemetic to treat nausea and vomiting following chemotherapy....
   (Zofran)
• Tropisetron
  Tropisetron
  
  Tropisetron is a serotonin 5-HT3 antagonist used mainly as an antiemetic to treat nausea and vomiting following chemotherapy, although it has been used experimentally as an analgesic in cases of fibromyalgia....
   (Navoban)
• Palonosetron
  Palonosetron
  
  Palonosetron is a 5-HT3 antagonist used in the prevention and treatment of chemotherapy-induced nausea and vomiting . It is the most effective of the 5-HT3 antagonists in controlling delayed CINV?nausea and vomiting that appear more than 24 hours after the first dose of a course of chemotherapy?and is the only drug of its class ap...
   (Aloxi)
• Mirtazapine
  Mirtazapine
  
  Mirtazapine is an antidepressant introduced by Organon International in 1994 used for the treatment of moderate to severe clinical depression....
   (Remeron)
• Dopamine antagonist
  Dopamine antagonist
  
  A dopamine antagonist is a drug which blocks dopamine receptors by receptor antagonism. There are five types of dopamine receptors in the human body; they are found in the brain, peripheral nervous system, blood vessels, and the kidney)....
  s act in the brain and are used to treat nausea and vomiting associated with neoplastic disease, radiation sickness, opioids, cytotoxic drugs and general anaesthetics.
• Domperidone
  Domperidone
  
  Domperidone is an antidopaminergic medication, developed by Janssen Pharmaceutica, and used orally, rectally or intravenously, generally to suppress nausea and vomiting....
  
• Droperidol
  Droperidol
  
  Droperidol is an antidopaminergic medication used as an antiemetic and antipsychotic. Discovered at Janssen Pharmaceutica in 1961, it is a butyrophenone, and is a potent D2 antagonist with some histamine and serotonin antagonist activity....
  , haloperidol
  Haloperidol
  
  Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacology similar to the phenothiazines....
  , chlorpromazine
  Chlorpromazine
  
  Chlorpromazine is a phenothiazine antipsychotic, and the oldest in the antipsychotic family of drugs. It is a typical antipsychotic. It is principally used in the treatment of schizophrenia, though it has also been used to treat severe manic episodes in people with bipolar disorder....
  , promethazine
  Promethazine
  
  Promethazine is a first-generation histamine H1 receptor antagonist, antihistamine and antiemetic medication. It can also have strong sedative effects although it is rarely used specifically for this....
  , prochlorperazine
  Prochlorperazine
  
  Prochlorperazine is a drug that belongs to the phenothiazine class of antipsychotic agents that are used for the treatment of nausea and vertigo ....
  . Some of these drugs are limited in their usefullness by their extra-pyramidal
  Extrapyramidal system
  
  In human anatomy, the extrapyramidal system is a neural network located in the human brain that is part of the motor system involved in the coordination of movement....
   and sedative side-effects.
• Metoclopramide
  Metoclopramide
  
  Metoclopramide is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties. Thus it is primarily used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastroparesis....
   (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.
• Alizapride
  Alizapride
  
  Alizapride is a dopamine antagonist with prokinetic and antiemetic effects used in the treatment of nausea and vomiting, including postoperative nausea and vomiting....
  
• Antihistamine
  Antihistamine
  
  An H1 antagonist is a histamine antagonist of the histamine H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergy....
  s (H₁ histamine receptor
  Histamine receptor
  
  The histamine receptors are a class of G-protein coupled receptors with histamine as their endogenous ligand.There are four known histamine receptors:...
   antagonists), effective in many conditions, including motion sickness and severe morning sickness in pregnancy.
• Cyclizine
  Cyclizine
  
  Cyclizine is an antihistamine drug used to treat nausea, vomiting and dizziness associated with motion sickness, Vertigo and post-operative following administration of general anaesthesia and opioids....
  
• Diphenhydramine
  Diphenhydramine
  
  Diphenhydramine hydrochloride , trade name Benadryl as produced by McNeil Laboratories a division of J&J, or Dimedrol outside the U.S....
   (Benadryl)
• Dimenhydrinate
  Dimenhydrinate
  
  Dimenhydrinate is an over-the-counter drug used to prevent nausea and motion sickness. It is marketed in Portugal as Viabom, but in prescription format....
   (Gravol, Dramamine)
• Meclizine
  Meclizine
  
  Meclizine is an antihistamine considered to be an antiemetic. It is sold under the brand names of Bonine, Bonamine, Antivert and Postafen and is most commonly used to inhibit nausea and vomiting....
   (Bonine, Antivert)
• Promethazine
  Promethazine
  
  Promethazine is a first-generation histamine H1 receptor antagonist, antihistamine and antiemetic medication. It can also have strong sedative effects although it is rarely used specifically for this....
   (Pentazine, Phenergan, Promacot)
• Hydroxyzine
  Hydroxyzine
  
  Hydroxyzine is a first-generation antihistamine, of the piperazine class that is an histamine receptor antagonist. It was synthesised in the early 1950s and the medicinal formulation of this drug was announced in the 04 August 1956 issue of Chemistry Week....
  
• Cannabinoids are used in patients with cachexia
  Cachexia
  
  Cachexia is weight loss, muscle atrophy, fatigue, weakness and significant anorexia in someone who is not actively trying to lose weight. It can be a sign of various underlying disorders; when a patient presents with cachexia, a doctor will generally consider the possibility of cancer, metabolic acidosis , certain infectious diseases , and...
  , cytotoxic nausea, and vomiting, or who are unresponsive to other agents.
• Cannabis
  Medical cannabis
  
  Medical cannabis refers to the use of the Cannabis plant as a physician-recommended Cannabis or herbal therapy as well as synthetic THC and cannabinoids....
   (Marijuana). Most patients prefer smoked or vaporized cannabis over pharmaceutical versions because they do not contain all 66 cannabinoids that are in cannabis, many of which have medicinal applications. Medical marijuana is also much less expensive than related pharmaceuticals. CBD
  Cannabidiol
  
  Cannabidiol, also known as CBD, is a Cannabinoids found in Cannabis. It is a major constituent of the plant, representing up to 40% in its extracts....
   is a main cannabinoid not in Marinol or Cesamet.
• Dronabinol (Marinol). Ninety percent of sales are for cancer and AIDS patients. The other 10% of its sales thought to be for pain, Multiple Sclerosis
  Multiple sclerosis
  
  Multiple sclerosis is an autoimmune disease in which the immune system attacks the central nervous system, leading to demyelinating disease. Disease onset usually occurs in young adults, and it is more common in females....
   and also for Alzheimer's disease
  Alzheimer's disease
  
  Alzheimer's disease , also called Alzheimer disease, Senile Dementia of the Alzheimer Type or simply Alzheimer's, is the most common form of dementia....
  .
• Nabilone
  Nabilone
  
  Nabilone is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain.It is a synthetic cannabinoid, which mimics the main ingredient of cannabis ....
   (Cesamet). Put back on the market in late 2006. In the US, it is a Schedule II substance unlike Marinol which is Schedule III and cannabis which is Schedule I.
• Sativex
  Sativex
  
  Sativex is an oromucosal spray developed by the UK company for multiple sclerosis patients, who can use it to alleviate neuropathic pain and spasticity, also Sativex is being prescribed to alleviate pain due to cancer, research is being made on Sativex to cure cancer and other diseases that involve mutant cells....
   is an oral spray containing THC and CBD. It is currently legal in Canada and a few countries in Europe but not in the U.S.
• Benzodiazepines
• Midazolam
  Midazolam
  
  Midazolam, pronounced m?'d?z?l?m is a drug which is a benzodiazepine derivative . It has potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant and sedative properties....
   given at the onset of anesthesia has been shown in recent trials to be as effective as ondansetron
  Ondansetron
  
  Ondansetron or GlaxoSmithKline's Zofran is a serotonin 5-HT3 antagonist used mainly as an antiemetic to treat nausea and vomiting following chemotherapy....
  , a 5-HT₃ antagonist in the prevention of post-operative nausea and vomiting. Further studies need to be undertaken.
• Lorazepam
  Lorazepam
  
  Lorazepam, initially marketed under the brand names Ativan and Temesta, is a benzodiazepine drug with short to medium duration of action....
   said to be very good as an adjunct treatment for nausea along with first line medications such as Compazine or Zofran.
• Anticholinergic
  Anticholinergic
  
  An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central nervous system and the peripheral nervous system....
  s
• Hyoscine (also known as scopolamine
  Scopolamine
  
  Scopolamine, known by the names levo-duboisine and hyoscine, is a tropane alkaloid Medication with muscarinic antagonist effects. It is obtained from plants of the family Solanaceae , such as henbane, jimson weed and Angel's Trumpets , and corkwood ....
  )
• Steroid
  Steroid
  
  A steroid is a terpenoid lipid characterized by a carbon skeleton with four fused rings, generally arranged in a 6-6-6-5 fashion.Steroids vary by the functional groups attached to these rings and the oxidation state of the rings....
  s
• Dexamethasone
  Dexamethasone
  
  Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. It acts as an anti-inflammatory and immunosuppressive drug....
   given in low dose at the onset of a general anaesthetic for surgery is an effective anti-emetic. The specific mechanism of action is not fully understood.
• NK1 receptor antagonist
  NK1 receptor antagonist
  
  Neurokinin NK1 antagonists are a novel class of medications that possesses unique antidepressant, anxiolytic, and antiemetic properties. The discovery of neurokinin 1 receptor antagonists was a turning point in the prevention of nausea and vomiting associated with cancer chemotherapy....
  
• Aprepitant
  Aprepitant
  
  Aprepitant is a chemical compound that belongs to a class of drugs called substance P antagonists . It mediates its effect by acting on neurokinin 1 receptor....
   Commercially available NK1 Receptor antagonist
• Casopitant
  Casopitant
  
  Casopitant is an neurokinin 1 receptor antagonist undergoing research for the treatment of chemotherapy-induced nausea and vomiting . It is developed by GlaxoSmithKline and is likely to be marketed in the US as Rezonic and in the EU as Zunrisa....
   Investigational NK1 receptor antagonist
• Other
• Trimethobenzamide
  Trimethobenzamide
  
  Trimethobenzamide is a medication frequently used as an antiemetic to prevent nausea and vomiting. It is often prescribed for patients with gastroenteritis, medication-induced nausea, and other illnesses....
  ; thought to work on the CTZ
  Chemoreceptor trigger zone
  
  The Chemoreceptor trigger zone is an area of the brain which receives inputs from blood-borne drugs or hormones, and communicates with the Vomiting center, to initiate vomiting....
  
• Ginger
  Ginger
  
  Ginger is a spice which is used for cooking and is also consumed whole as a delicacy or medicine. It is the rhizome of the Zingiber, Zingiber officinale....
  
• Emetrol
  Emetrol
  
  Emetrol is the brand name of an over-the-counter antiemetic medicine taken to relieve nausea and vomiting. It is a mixture of glucose, fructose, and phosphoric acid, and comes in syrup form....
   also claimed to be an effective antiemetic.
• Propofol
  Propofol
  
  Propofol is a short-acting intravenous sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, and sedation in medical contexts, such as intensive care unit sedation for intubated, mechanically ventilated adults, and in procedures such as colonoscopies and endoscopies....
   given intravenously. It has been used in an acute care setting in hospital as a rescue therapy for emesis.
• Peppermint
  Peppermint
  
  Peppermint is a Hybrid Mentha, a cross between the watermint and spearmint . The plant, indigenous to Europe, is now widespread in cultivation throughout all regions of the world....
   claimed to help nausea or stomach pain when added into a tea or peppermint candies.
• Muscimol
  Muscimol
  
  Muscimol is the major psychoactive alkaloid present in many mushrooms of the Amanita genus. Unlike psilocybin, a tryptamine, muscimol is a potent, selective agonist of the GABA A receptor receptor....
   purported as such
• Ajwain
  Ajwain
  
  Ajwain or Ajowan Caraway , is an uncommon spice except in certain areas of Asia....
   purported to be antiemetic. It is a popular spice in India
  India
  
  India, officially the Republic of India , is a country in South Asia. It is the List of countries and outlying territories by total area country by geographical area, the List of countries by population country, and the most populous liberal democracy in the world....
  , Ethiopia
  Ethiopia
  
  Ethiopia , officially the Federal Democratic Republic of Ethiopia, is a landlocked country situated in the Horn of Africa. Ethiopia is bordered by Eritrea to the north, Sudan to the west, Kenya to the south, Somalia to the east and Djibouti to the northeast....
   and Eritrea
  Eritrea
  
  Eritrea , officially the Country of Eritrea, is a country in Northeast Africa. It is bordered by Sudan in the west, Ethiopia in the south, and Djibouti in the southeast....
  .

• Non-pharmaceutical therapies with some evidence of efficacy include acupuncture and hypnosis. All drugs have potential side effects. It is important to try to reduce the baseline risk of nausea and vomiting, particularly with respect to surgery.

See also

• Emetic
• Hyperemesis gravidarum
  Hyperemesis gravidarum
  
  Hyperemesis gravidarum is a severe form of morning sickness, with unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. Hyperemesis is considered a rare complication of pregnancy but, because nausea and vomiting during pregnancy exist on a continuum, there is often not a good d...
  
• Chemotherapy
  Chemotherapy
  
  Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer....