Nausea and Vomiting

Chemotherapy-Induced Nausea and Vomiting (CINV)

• Dexamethasone is the most commonly used corticosteroid in the management of CINV.
• Dexamethasone is effective in preventing both cisplatin-induced acute emesis and delayed nausea and vomiting.
• Dexamethasone is used alone or in combination with 5-HT3-RAs.

Postoperative Nausea and Vomiting (PONV)

• Dexamethasone is used in the management of PONV, either as a single agent or in combination with 5-HT3-RAs.

Metoclopramide

• Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis.
• Metoclopramide is used with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration.

Cannabinoids

• Nabilone (Cesamet) and dronabinol (Marinol) are therapeutic options when CINV is refractory to other antiemetics.
• Nabilone and dronabinol are man-made forms of THC (tetrahydrocannabinol) from cannabis.

Neurokinin 1 Receptor Antagonists

• Substance P is a peptide neurotransmitter with a preferred receptor, NK1.
• Aprepitant and fosaprepitant (injectable form of aprepitant) are NK1 receptor antagonists.
• NK1 receptor antagonists are indicated as part of a multiple drug regimen for prophylaxis of nausea and vomiting associated with high-dose cisplatin-based chemotherapy.

5-Hydroxytryptamine-3 Receptor Antagonists (5-HT3-RAs)

• 5-HT3-RAs (dolasetron, granisetron, ondansetron, and palonosetron) are used in the management of CINV, PONV, and radiation-induced nausea and vomiting.
• Common side effects of 5-HT3-RAs include constipation, headache, and asthenia.

Disorders of Balance

• Scopolamine is effective for the prevention of motion sickness and is considered first-line for this indication.

Antiemetic Use During Pregnancy

• Initial management of nausea and vomiting of pregnancy (NVP) often involves dietary changes and/or lifestyle modifications.
• Pyridoxine (10–25 mg one to four times daily) is recommended as first-line therapy with or without doxylamine (12.5–20 mg one to four times daily).
• Ondansetron, promethazine, and metoclopramide have similar effectiveness for hyperemesis gravidarum, although ondansetron may be better tolerated due to less adverse effects.

Hyperemesis Gravidarum

• Hyperemesis gravidarum is a medical term for severe nausea and vomiting during pregnancy.
• Symptoms may lead to dehydration, weight loss, and electrolyte imbalance.

Antiemetic Use in Children

• For children receiving chemotherapy of high or moderate risk, a corticosteroid (such as dexamethasone) plus 5-HT3-RAs should be administered.
• There is greater emphasis on rehydration measures than on pharmacologic intervention for nausea and vomiting associated with pediatric gastroenteritis.