Safety and efficacy of commonly used antiemetics

Abstract

The key to providing relief for patients suffering from nausea and vomiting is to consider multiple drugs to approach the nausea in a systematic way. Anesthesiologists identify patients who are at high risk of nausea and vomiting based on physical characteristics and surgical procedures. Oncologists treat nausea based on the prescribed chemotherapeutics regimen and known risk of emesis while palliative care physicians and others balance the etiology of the nausea while optimizing patients other co morbid conditions.

An assay of drug‐induced emesis in the squirrel monkey (Saimiri sciureus)

“…Moreover, the ability to incorporate emetic and antiemetic findings within behavioral, cognitive, and neural methodologies that are already well‐established in the non‐human primate could facilitate the development of safer and more effective pharmacotherapies. These advantages are particularly important in light of the fact that nearly all currently prescribed antiemetics (eg, ondansetron, nabilone, scopolamine) and also those under investigation (eg, cannabidiol) interact with complex neurotransmitter systems in the brain and have behavioral side effects, ranging from sedation or restlessness to cognitive disruption and, in rare cases, psychosis . In addition, some currently available antiemetics appear to have abuse liability, for example, the antihistamine cyclizine, likely due to its stimulant effects .…”

“…These advantages are particularly important in light of the fact that nearly all currently prescribed antiemetics (eg, ondansetron, nabilone, scopolamine) and also those under investigation (eg, cannabidiol) interact with complex neurotransmitter systems in the brain and have behavioral side effects, ranging from sedation or restlessness to cognitive disruption and, in rare cases, psychosis. 77,78 In addition, some currently available antiemetics appear to have abuse liability, for example, the antihistamine cyclizine, likely due to its stimulant effects. 79 the present findings indicate that the squirrel monkey is sensitive to a variety of emetic triggers and, therefore, is well-positioned to serve as a laboratory subject in studies investigating emetic mechanisms and antiemetic drug development.…”

Post-Operative Patients;

“…2 Among the many anti-emetics in current use the antagonists of 5-HT3 receptor (5-HT3 RAs) are said to be playing an effective role in treatment of POV. 3 The target site for this class of drugs is an ion channel that is ligand gated -5-HT3 receptor. In humans multiple subunits of this receptor from A, B, C, D to E have been identified.…”

Review article: Antiemetics in the pre‐hospital setting: A systematic review of efficacy and safety

“…For example, in nausea and vomiting because of motion sickness, anti-histamine agents such as promethazine have been shown superior to other antiemetics 2 whereas in postoperative nausea and paediatric gastroenetritis, ondansetron has been shown to be effective. 5 However, the frequency and type of antiemetics used in the acute and pre-hospital setting varies from country to country. 4 Antiemetics like other pharmacological agents have a range of adverse effects.…”

“…For example, metoclopramide is associated with akathesia, ondansetron is associated with headaches and QT interval prolongation and promethazine is associated with phlebitis. 5 However, the frequency and type of antiemetics used in the acute and pre-hospital setting varies from country to country. Ondansetron is the most commonly used antiemetic worldwide in pre-hospital settings, even though there is limited evidence available to demonstrate its efficacy.…”