Antiemetics (antiemetic drugs, antiemetics) are used against vomiting and nausea, including the treatment of motion sickness. They are also given to counteract the side effects of anesthetics after general anesthesia and chemotherapy in cancer.

  1. What is vomiting?
  2. Antiemetics - breakdown
  3. Herbs with antiemetic effect
  4. How to support the body when vomiting occurs?

Antiemetics( antiemetic drugs ,antiemetics ) are prescribed in most cases by prescription . They are most often used in the case of motion sickness, but also pathological vomiting in the case of poisoning or against vomiting resulting from the use of opioid anesthetics, after general anesthesia and after chemotherapy in cancer.

What is vomiting?

Vomiting is technically defined as a sudden and uncontrolled discharge of food from the stomach as a result of strong contractions of the abdominal, diaphragm, and chest muscles. Vomiting is often accompanied by nausea.

Vomiting can be caused by both physiological and pathological factors. Both are the result of stimulation of the emetic centers of the reticular formation in the medulla. This stimulation may come from the vestibular apparatus of the ear, stomach, intestines, etc. Vomiting may be a reaction to visceral pain, it can also be induced independently (not necessarily on purpose), mechanically irritating the soft palate.

Statistically, vomiting is the most common consequence of acute food poisoning.

Pathological vomiting, in turn, most often occurs as a result of medications, such as anti-cancer drugs, non-steroidal anti-inflammatory drugs, erythromycin, sulfasalazine. They can also be the result of hormonal disorders, diseases of the central nervous system, gastrointestinal tract and peritoneum.

Antiemetics - breakdown

  • Benzamide derivative prokinetics

Prokinetic drugs are used not only to inhibit vomiting, but also in diseases of the upper gastrointestinal tract, reflux disease and in gastroparesis (i.e. in disorders of the digestive system). Their mechanismit works by tightening the gastric inlet sphincter muscle and improving the peristalsis of the esophagus, stomach and duodenum.

The main drugs in this group are metoclopramide, domperidone and cisapride. These substances have a dopaminolytic effect, which, unfortunately, may cause side effects on the part of the central nervous system, most often they are: fatigue, drowsiness and anxiety.

In addition, there may be hormonal disorders and cardiovascular symptoms, e.g. cardiac arrhythmia, hypotension, or on the contrary - hypertension.

  • 5-HT3 Serotonin Receptor Antagonists

As the name suggests, these drugs block serotonin 5-HT3 receptors found in both the central and peripheral nervous systems. They inhibit nausea and vomiting resulting from the action of serotonin released in the small intestine, e.g. by cytostatic drugs and radiotherapy. The most popular and the first approved substance in this group is ondansetron.

The main indication for their administration is vomiting induced by chemotherapy and radiotherapy, as well as postoperative vomiting, sometimes they are also recommended in incontinent vomiting of pregnancy (which in this case may endanger the he alth and life of the mother and child).

Drugs from this group can be administered intravenously, orally, there are also drugs in the form of suppositories and patches. The method of their administration depends both on the disease and the general condition of the patient. They are relatively safe and cause few side effects, such as headaches, dizziness, reddening of the skin, hot flashes, and fatigue.

  • Neuroleptics

Neuroleptics block dopamine D2 receptors located in the brainstem. Until the 1980s, they were the first-line drugs in the treatment of vomiting, but today, due to their severe side effects, they are not prescribed as first-line drugs.

Neuroleptics can be used in the course of diseases of the gastrointestinal tract, in radiation sickness and in disorders of the water and electrolyte balance. They are also used to counteract drug-induced vomiting (e.g. induced by opioid analgesics, estrogens and cytostatics).

Some are effective against vomiting of labyrinthine origin and vomiting in pregnant women.

Chlorpromazine, perphenazine and thiethylperazine are most commonly used. Unfortunately, drugs from this group can cause blood pressure reduction, dry mucous membranes and urinary retention.

The group of neuroleptics also includes haloperidol and droperidol, which prevent and treat vomitingpostoperative.

  • Antagonists of NK1 neurokinin receptors of substance P

Substances from this group are used in the treatment of vomiting induced by anti-cancer therapy, as well as in the prevention and treatment of postoperative vomiting. They also inhibit vomiting in patients taking medications with an emetogenic potential. They are also used in combination therapy with the 5-HT3 antagonist and dexamethasone.

The most frequently used substance from this group is aprepitant.

Unfortunately, like any drug, it can cause some side effects, mainly:

  • hiccup
  • weakness and general fatigue
  • constipation or diarrhea
  • as well as dizziness and headaches
  • Antihistamines

First-generation antihistamines, i.e. those blocking the histamine H1 receptor, are also used in the treatment of vomiting. The indication for the administration of these substances is vomiting of labyrinthine origin and vomiting induced by motion sickness.

Most commonly administered for this purpose are: dimenhydrinate, diphenhydramine, chlorphenamine (over-the-counter), and promethazine. To prevent vomiting, it is usually given by mouth. After taking them, a side effect may occur: drowsiness, which is difficult to control, but not everyone does.

  • Benzodiazepines

Drugs from this group are rarely used alone - they are usually combined with other antiemetics. They are most often prescribed when vomiting does not respond to standard treatment, especially if it is induced by chemotherapy or occurs after surgery. The most commonly used substances from this group are midazolam and lorazepam.

  • Cannabinoids

Cannabinoids are most often used to prevent and treat nausea and vomiting in people undergoing chemotherapy when other drugs are ineffective (this limitation is related to side effects that are difficult to predict). The most commonly used are dronabinol found in cannabis and nabilone.

The mechanism of the antiemetic action of these substances is not fully known, but it is believed that it affects cannabinoid receptors located in or near the emetic center.

Cannabinoids have side effects, which mainly include unpleasant experiences and disorders of the central nervous system, such as: mood disorders, drowsiness, dizziness, confusion, hallucinations and psychoses.

Other side effects include palpitationsheart, tachycardia, orthostatic hypotension, conjunctival hyperaemia and dry mouth.

It is worth noting that while taking cannabinoids you cannot drive or operate machinery.

  • Cholinolytic drugs

Hyoscine is the most commonly used and the most popular of all cholinolytic drugs. It is used in the prevention and treatment of vomiting in motion sickness.

In the prevention of vomiting in kinetosis (i.e. motion sickness), hyoscine is administered in the form of patches applied to the skin behind the ears - they should be applied at least 6 hours before the trip, and the effect lasts for 72 hours.

After administration of the drug through the skin, the most common side effect is dry mouth mucosa, and after repeated administration of the drug in this way, visual disturbances in the form of disturbances in accommodation are observed. In addition, attention may deteriorate and memory difficulties may occur.

According to studies, addiction and psychosis are observed after at least a month's use of hyoscine, and 10% of patients may also experience skin changes (e.g. contact dermatitis).

The preparation administered in this way can also induce an acute attack of glaucoma and therefore should not be used in people who have glaucoma.

  • Other antiemetics

It is worth mentioning that drugs belonging to other groups, such as cinnarizine and flunarizine, which are calcium channel antagonists and have an antihistamine effect, also have the effect of suppressing nausea and vomiting. They are also used in the prevention and treatment of motion sickness.

Herbs with antiemetic effect

A herb with proven antiemetic effect is the ginger rhizome ( Zingiberis rhizoma ). You can take the raw material itself, as well as teas, candies, capsules or tablets with ginger. It can also be used under medical supervision to relieve vomiting in pregnancy.

Ginger capsules are also a suitable medicine for vomiting for a child over 6 years old. They can also be used by children of this age and adults as a prophylaxis of motion sickness.

How to support the body when vomiting occurs?

Vomiting can easily lead to dehydration.

Therefore, remember that the patient should replenish the lost fluids in small portions. Ideally, they should be cool - it reduces the gag reflex.

The risk of dehydration in vomiting increases when accompanied by diarrhea and sometimes has an elevated body temperature.In this case, it is absolutely necessary to consult a doctor.

During vomiting, it is also recommended to drink herbal teas, e.g. lemon balm or chamomile, which are not only anti-inflammatory, but also diastolic.

Liquids should be taken slowly and in small amounts.

You can also help your grandmothers, such as chewing a peppermint leaf or a clove.

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