27 Jul 2010
Types of Antiemetics, Antiemetics include:
* 5-HT3 receptor antagonists – these 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.
o Dolasetron (Anzemet) - can be administered in tablet form or in an injection.
o Granisetron (Kytril, Sancuso) - can be administered in tablet (Kytril), oral solution (Kytril), or in a single transdermal patch to the upper arm (SANCUSO).
o Ondansetron (Zofran) - administered in an oral tablet form, oral dissolving tablet form, or in an injection.
o Tropisetron (Navoban) - can be administered in oral capsules or in injection form.
o Palonosetron (Aloxi) - can be administered in an injection or in oral capsules.
o Mirtazapine (Remeron), an antidepressant that also has antiemetic effects.
* 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.
o Droperidol, haloperidol, chlorpromazine, promethazine, prochlorperazine. Some of these drugs are limited in their usefulness by their extra-pyramidal and sedative side-effects.
o 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.
* NK1 receptor antagonist
o Aprepitant (Emend) Commercially available NK1 Receptor antagonist
o Casopitant Investigational NK1 receptor antagonist
* Antihistamines (H1 histamine receptor antagonists), effective in many conditions, including motion sickness, morning sickness in pregnancy, and to combat opiate nausea.
o Diphenhydramine (Benadryl)
o Dimenhydrinate (Gravol, Dramamine)
o Meclizine (Bonine, Antivert)
o Promethazine (Pentazine, Phenergan, Promacot) Promethazine can be administered via a rectal suppository for adults and children over 2 years of age.
* Cannabinoids are used in patients with cachexia, cytotoxic nausea, and vomiting, or who are unresponsive to other agents.
o Cannabis - Medical marijuana, in the U.S., it is a Schedule I drug.
o Dronabinol (Marinol) - a Schedule III drug in the U.S.
o Nabilone (Cesamet) - Put back on the market in late 2006. In the U.S., it is a Schedule II substance.
o 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.
o Midazolam given at the onset of anesthesia has been shown in recent trials to be as effective as ondansetron.
o Lorazepam said to be very good as an adjunct treatment for nausea along with first line medications such as Compazine or Zofran.
o Hyoscine (also known as scopolamine)
o Dexamethasone given in low dose at the onset of a general anaesthetic is an effective anti-emetic. The specific mechanism of action is not fully understood.
o Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil)
o Trimethobenzamide; thought to work on the CTZ
o Emetrol also claimed to be an effective antiemetic.
o Propofol given intravenously. It has been used in an acute care setting in hospital as a rescue therapy for emesis.
o Peppermint claimed to help nausea or stomach pain when added into a tea or peppermint candies.
o Muscimol purported as such
o Ajwain purported to be antiemetic. It is a popular spice in India, Ethiopia and Eritrea.
o Zolpidem has been reported to be a newer antiemetic used for patients that have been unresponsive to other first-line typical antiemetics.
* Non-pharmaceutical therapies with some evidence of efficacy include acupuncture, hypnosis, and with great efficacy, cannabis.
Hope the info helps?
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