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Monday, October 3, 2011

Vomiting - Treatment of vomiting, classification and adverse effects of antiemetic drugs

Treatment of vomiting:

Treatment of vomiting varies with its cause, which can be found out by looking at the patient’s clinical presentation.

Reversible causes of vomiting such as hypercalcemia, constipation should be treated accordingly.
If vomiting is caused by a particular drug then that drug should be stopped if possible.

Antiemetic drugs can be given once the probable cause is found out. This is because the receptors that lead to vomiting vary with the cause, eg dopamine receptors in the chemoreceptor trigger zone are stimulated by metabolic and drug causes of nausea and vomiting, whereas gastric irritation stimulates histamine receptors in the vomiting centre via the vagus nerve. So based on the receptors activated, the antiemetic drugs are prescribed.

Classification of Antiemetic agents:

Before prescribing any of the antiemetic agents it is important to find out the cause of vomiting and the type of receptors involved. Combination of antiemetic agents with different mechanism of actions are often used especially in patients with vomiting due to drugs.

Antiemetic agents
Used to prevent nausea & vomiting due to:
1. Seretonin 5 HT3 antagonists
·         Onadensetron
·         Granisetron
·         Dolasetron
·         Palonosetron

2. Corticosteroids
·         Dexamethasone
·         Methylprednisolone

3. Neurokinin receptor antagonists
·         Aprepitant
·         Fosaprepitant

4. Phenothiazines
·         Prochlorperazine
·         Promethazine
·         Thiethyperazine

Hyperemesis gravidarum
5. Butyrophenones
·         Droperidol
·         Heloperidol

6. Substituted Benzamines
·         Metoclopramide
·         Trimethobenzamide

7. H1 AntiHistamines & Anticholinergic drugs
·         Diphenhydramine
·         Dimenhydrinate
·         Meclizine
·         Hyoscine

Motion sickness
8. Benzodiazepines
·         Lorazepam
·         Diazepam

Anticipatory vomiting
9. Cannabinoids
·         Dronabinol
·         Nabilone


Table: Anti-emetic drugs

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Adverse / Side effects of antiemetics:

1. Drowsiness

2. Anti-muscarinic effects (atropine like side effects):

·         Dry mouth
·         Blurred vision
·         Constipation
·         Urinary retention

3. Gynaecomastia, Galactorrhoea (D2 receptor antagonist)

4. CNS disturbances like Somnolence

5. Sedation (Droperidol, Diphenhydramine)

6. Cardiac arrhythmias (Droperidol)

Reference: The following books were used in the making of the above article:

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