Antiemetic drugs help to block specific neurotransmitters in the body. These neurotransmitters trigger impulses such as nausea and vomiting, so blocking the impulses will help shut them down.
Feeling nauseated might seem like a simple reaction in the body, but it is a complex process. Because of this, there is a range of antiemetic drugs, each of which is designed to work in different situations.
Types of antiemetic drugs
There are many different causes of nausea, and certain classes of antiemetic drugs are designed to treat each cause. Below are the most common antiemetic drugs, grouped by the kind of nausea they can treat:
Antiemetic drugs for motion sickness
Some antiemetic drugs may help to prevent vomiting and nausea caused by travel.
Some antihistamine medications may help prevent nausea and vomiting caused by motion sickness. A few of these medications are available as over-the-counter drugs.
These medications desensitize the inner ear to the motion of the head. The inner ear plays a significant role in a person's balance, which can be affected by sitting in a moving car or being on a boat.
Antiemetics for motion sickness include:
- dimenhydrinate (Dramamine, Gravol)
- diphenhydramine (Benadryl)
- meclizine (Bonine)
- promethazine (Phenergan)
Each of these medications may cause side effects, which a person should discuss with a doctor or pharmacist if they have not used a drug before.
Antiemetic drugs for surgery
People who require anesthesia to undergo surgery frequently complain of nausea and vomiting following the surgery. A few different types of drugs can help with this, such as serotonin receptor blockers, dopamine receptor blockers, and some corticosteroids.
Antiemetic drugs doctors may prescribe after surgery include:
- dexamethasone (Decadron)
- droperidol (Inapsine)
- metoclopramide (Reglan)
- ondansetron (Zofran)
Antiemetic drugs for cancer patients and chemotherapy
Chemotherapy treatment will often cause nausea and vomiting. Doctors may prescribe different antiemetic drugs both before and after chemotherapy treatment to help prevent symptoms and allow the person to experience a higher quality of life.
Different types of drugs may help with this, including serotonin and dopamine receptor blockers, NK1 receptor blockers, and corticosteroids.
Some antiemetic drugs for chemotherapy include:
- aprepitant (Emend)
- dexamethasone (DexPak)
- dolasetron (Anzemet)
- granisetron (Kytril)
- ondansetron (Zofran)
- palonosetron (Aloxi)
- prochlorperazine (Compazine)
- rolapitant (Varubi)
Cannabinoids from medical marijuana or prescription drugs such as dronabinol (Marinol) also show promise in reducing symptoms of nausea and vomiting in people who respond negatively to other drugs. These drugs still have a risk of side effects, however.
Antiemetics for stomach flu
Some cases of gastroenteritis, known commonly as the stomach flu, may require antiemetics to relieve symptoms.
While vomiting can help get rid of stomach irritants, excessive vomiting can damage the digestive tract. Nausea may also prevent a person with the stomach flu from eating, even though their body needs nutrients.
Over-the-counter medications such as sodium citrate/dextrose/fructose (Nauzene), phosphoric acid (Emitrol), or bismuth subsalicylate (Pepto-Bismol) can help soothe an upset stomach as the body fights off the infection.
Antiemetics during pregnancy
Pregnant women with morning sickness may use antiemetic drugs to reduce their symptoms. They are usually only prescribed in severe situations, such as if a woman has hyperemesis gravidarum or where nausea and vomiting interfere with everyday life.
A few different medications may work as antiemetics during pregnancy. Doctors will want to discuss any possible side effects of each drug on the mother and baby.
Some antiemetics for morning sickness include:
- dimenhydrinate (Dramamine)
- prochlorperazine (Compazine)
- promethazine (Pentazine)
Doctors may also prescribe metoclopramide (Reglan) for women who do not respond well to other treatments. Using cannabis or marijuana during pregnancy is not safe, as it may affect the developing fetus.
It is recommended to discuss any potential side effects of antiemetic drugs with a pharmacist or doctor.
Each antiemetic drug may have a specific list of side effects, so a person should be sure to read the information that comes with their particular medication, or ask the pharmacist to go over the side effects with them.
Understanding which side effects a person is most sensitive to may help doctors choose the best prescription to treat their symptoms.
Common side effects of each drug type include:
- Antihistamines: sleepiness, dry mouth, and dry nasal passages
- Bismuth-subsalicylate: dark, blackish stools and changes in tongue color
- Cannabinoids: altered state of perception and dizziness
- Corticosteroids: additional symptoms of indigestion, increased appetite or thirst, and acne
- Dopamine receptor blockers: fatigue, constipation, ringing in the ears, dry mouth, restlessness, and muscle spasms
- NK1 receptor blockers: dry mouth, reduced urine volume, and heartburn
- Serotonin receptor blockers: fatigue, dry mouth, and constipation
Each specific medication may have additional side effects as well.
While antiemetic drugs can help people to live without the bothersome symptoms of nausea and vomiting, some complications can occur.
Symptoms that should be addressed by a doctor include:
- muscle weakness, spasms, or convulsions
- changes in heartbeat, such as palpitations or rapid heartbeat
- hearing loss
- worsening of nausea or vomiting, even while taking medications
- slurred speech
- psychological problems, such as hallucinations or confusion
- drowsiness that interferes with daily life
It is best to discuss medications with a doctor before starting any new prescription, especially if a person is taking other drugs.
For instance, people who take sleeping pills or muscle relaxants will need to talk to their doctor before taking over-the-counter antihistamines for nausea and vomiting.
Other medications have side effects similar to those caused by antiemetics. Taking more than one of these drugs at the same time may make the side effects worse.
Medications with similar side effects include:
The best known natural antiemetic is ginger root.
Some natural antiemetic options exist for people who want to avoid chemical drugs.
Ginger root is the best known natural antiemetic that is used to combat symptoms such as nausea and upset stomach. Ginger root is now available in candies, drinks, and teas.
As research has noted, ginger significantly reduces symptoms of nausea and vomiting in many people. More in-depth studies are needed to support these claims, but the initial evidence is positive.
The essential oils from some herbs may also help with nausea and vomiting. Peppermint, spearmint, lemon, and ginger essential oil may help with symptoms in many people and can be used by adding them to a diffuser or wafting a bottle under the nose.
Whether a person chooses a natural antiemetic or a chemical drug, it is always best to discuss any new treatments with a doctor. With a doctor's help, many people can find the right medicine to relieve symptoms of nausea and vomiting and avoid any other complications.
1. Naeim A, Dy SM, Lorenz KA, Sanati H, Walling A, Asch SM. Evidence-based recommendations for cancer nausea and vomiting. J Clin Oncol. 2008;26:3903–3910. doi: 10.1200/JCO.2007.15.9533.[PubMed][Cross Ref]
2. Schnell F. Chemotherapy-induced nausea and vomiting: the importance of acute antiemetic control. Oncologist. 2003;8(2):187–198. doi: 10.1634/theoncologist.8-2-187.[PubMed][Cross Ref]
3. Jordan K, Kasper C, Schmoll HJ. Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic prophylaxis and treatment. Eur J Cancer. 2005;41:199–205. doi: 10.1016/j.ejca.2004.09.026.[PubMed][Cross Ref]
4. Ballatori E, Roila F, Ruggeri B, Betti M, Sarti S, Soru G, et al. The impact of chemotherapy-induced nausea and vomiting on health-related quality of life. Support Care Cancer. 2007;15:179–185. doi: 10.1007/s00520-006-0109-7.[PubMed][Cross Ref]
5. Wit R, Aapro M, Blower PR. Is there a pharmacological basis for differences in 5-HT3-receptor antagonist efficacy in refractory patients? Cancer Chemother Pharmacol. 2005;56:231–238. doi: 10.1007/s00280-005-1033-0.[PubMed][Cross Ref]
6. Kaiser R, Tremblay PB, Sezer O, Possinger K, Roots I, Brockmoller J. Investigation of the association between 5-HT3A receptor gene polymorphisms and efficiency of antiemetic treatment with 5-HT3 receptor antagonists. Pharmacogenetics. 2004;14:271–278. doi: 10.1097/00008571-200405000-00001.[PubMed][Cross Ref]
7. Roila F, Hesketh PJ, Herrstedt J. Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol. 2006;17:20–28. doi: 10.1093/annonc/mdj936.[PubMed][Cross Ref]
8. Kris MG, Hesketh PJ, Somerfield MR, Feyer P, Clark-Snow R, Koeller JM, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol. 2006;24:2932–2947. doi: 10.1200/JCO.2006.06.9591.[PubMed][Cross Ref]
9. Hesketh PJ. Defining the emetogenicity of cancer chemotherapy regimens: relevance to clinical practice. Oncologist. 1999;4:191–196.[PubMed]
10. Rubenstein EB, Slusher BS, Rojas C, Navari RM. New approaches to chemotherapy-induced nausea and vomiting: from neuropharmacology to clinical investigations. Cancer J. 2006;12:341–347. doi: 10.1097/00130404-200609000-00003.[PubMed][Cross Ref]
11. Rang H, Dale M, Ritter J, Flower R. Pharmacology. 6 th, 391. 2007. Elsevier. ISBN: 9780443050473.
12. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008;358:2482–2494. doi: 10.1056/NEJMra0706547.[PubMed][Cross Ref]
13. Herrstedt J, Dombernowsky P. Anti-emetic therapy in cancer chemotherapy: current status. Basic Clin Pharmacol Toxicol. 2007;101:143–150. doi: 10.1111/j.1742-7843.2007.00122.x.[PubMed][Cross Ref]
14. Johnston KD. The potential for mu-opioid receptor agonists to be anti-emetic in humans: a review of clinical data. Acta Anaesthesiol Scand. 2010;54:132–140. doi: 10.1111/j.1399-6576.2009.02115.x.[PubMed][Cross Ref]
15. Ho KY, Gan TJ. Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Curr Opin Anaesthesiol. 2006;19:606–611. doi: 10.1097/01.aco.0000247340.61815.38.[PubMed][Cross Ref]
16. Niesler B, Kapeller J, Hammer C, Rappold G. Serotonin type 3 receptor genes: HTR3A, B, C, D, E. Pharmacogenomics. 2008;9:501–504. doi: 10.2217/146224126.96.36.1991.[PubMed][Cross Ref]
17. Herrstedt J. Antiemetic research: a look to the future. Support Care Cancer. 1998;6:8–12. doi: 10.1007/s005200050125.[PubMed][Cross Ref]
18. Blower PR. 5-HT3-receptor antagonists and the cytochrome P450 system: clinical implications. Cancer J. 2002;8:405–414. doi: 10.1097/00130404-200209000-00012.[PubMed][Cross Ref]
19. Wit R. Current position of 5HT3 antagonists and the additional value of NK1 antagonists; a new class of antiemetics. Br J Cancer. 2003;88:1823–1827. doi: 10.1038/sj.bjc.6601033.[PMC free article][PubMed][Cross Ref]
20. Kaiser R, Sezer O, Papies A, Bauer S, Schelenz C, Tremblay PB, et al. Patient-tailored antiemetic treatment with 5-hydroxytryptamine type 3 receptor antagonists according to cytochrome P-450 2D6 genotypes. J Clin Oncol. 2002;20:2805–2811. doi: 10.1200/JCO.2002.09.064.[PubMed][Cross Ref]
21. Stoltz R, Cyong JC, Shah A, Parisi S. Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in US and Japanese healthy subjects. J Clin Pharmacol. 2004;44:520–531. doi: 10.1177/0091270004264641.[PubMed][Cross Ref]
22. McEvoy GK. AHFS Drug Information. 2299, 2798,2800, 2850. 2004. American Society of Health System Pharmacist, Bethesda. ISBN:1585280585.
23. Page C, Curtis M, Sutter M, Walker M, Hoffman B. Integrated Pharmacology. London: Mosby International, 2002. ISBN: 978-0723432210.
24. Desta Z, Wu GM, Morocho AM, Flockhart DA. The gastroprokinetic and antiemetic drug metoclopramide is a substrate and inhibitor of cytochrome P450 2D6. Drug Metab Dispos. 2002;30:336–343. doi: 10.1124/dmd.30.3.336.[PubMed][Cross Ref]
25. Kudo S, Ishizaki T. Pharmacokinetics of haloperidol: an update. Clin Pharmacokinet. 1999;37:435–456. doi: 10.2165/00003088-199937060-00001.[PubMed][Cross Ref]
26. Herfindall E, Gourley D. Textbook of therapeutics, drug and disease management. Philadelphia: Lippincott Williams & Wilkins; 2000. ISBN: 9780781724159.
27. Williams D, Lemke T. Foye’s principal of medicinal chemistry. Baltimore: Lippincott Williams & Wilkins; 2002. ISBN: 978-0683307375.
28. Onaivi ES, Ishiguro H, Gong JP, Patel S, Meozzi PA, Myers L, et al. Functional expression of brain neuronal CB2 cannabinoid receptors are involved in the effects of drugs of abuse and in depression. Ann N Y Acad Sci. 2008;1139:434–449. doi: 10.1196/annals.1432.036.[PMC free article][PubMed][Cross Ref]
29. Lohr L. Chemotherapy-induced nausea and vomiting. Cancer J. 2008;14:85–93. doi: 10.1097/PPO.0b013e31816a0f07.[PubMed][Cross Ref]
30. Slatkin NE. Cannabinoids in the treatment of chemotherapy-induced nausea and vomiting: beyond prevention of acute emesis. J Support Oncol. 2007;5:1–9.[PubMed]
31. Jong FA, Engels FK, Mathijssen RH, van ZL, Verweij J, Peters RP, et al. Medicinal cannabis in oncology practice: still a bridge too far? J Clin Oncol. 2005;23:2886–2891. doi: 10.1200/JCO.2005.04.150.[PubMed][Cross Ref]
32. Patel L, Lindley C. Aprepitant—a novel NK1-receptor antagonist. Expert Opin Pharmacother. 2003;4:2279–2296. doi: 10.1517/146565188.8.131.529.[PubMed][Cross Ref]
33. Flemm LA. Aprepitant for chemotherapy-induced nausea and vomiting. Clin J Oncol Nurs. 2004;8:303–306. doi: 10.1188/04.CJON.303-306.[PubMed][Cross Ref]
34. Ruhlmann C, Herrstedt J. Casopitant: a novel NK(1)-receptor antagonist in the prevention of chemotherapy-induced nausea and vomiting. Ther Clin Risk Manag. 2009;5:375–384.[PMC free article][PubMed]
35. Abali H, Celik I. Tropisetron, ondansetron, and granisetron for control of chemotherapy-induced emesis in Turkish cancer patients: a comparison of efficacy, side-effect profile, and cost. Cancer Invest. 2007;25:135–139. doi: 10.1080/07357900701208709.[PubMed][Cross Ref]
36. Navari RM. Antiemetic control: toward a new standard of care for emetogenic chemotherapy. Expert Opin Pharmacother. 2009;10:629–644. doi: 10.1517/14656560902731894.[PubMed][Cross Ref]
37. Musso M, Scalone R, Bonanno V, Crescimanno A, Polizzi V, Porretto F, et al. Palonosetron (Aloxi®) and dexamethasone for the prevention of acute and delayed nausea and vomiting in patients receiving multiple-day chemotherapy. Support Care Cancer. 2008;17:205–209. doi: 10.1007/s00520-008-0510-5.[PubMed][Cross Ref]
38. Grunberg SM, Dugan M, Muss H, Wood M, Burdette-Radoux S, Weisberg T, et al. Effectiveness of a single-day three-drug regimen of dexamethasone, palonosetron, and aprepitant for the prevention of acute and delayed nausea and vomiting caused by moderately emetogenic chemotherapy. Support Care Cancer. 2009;17:589–594. doi: 10.1007/s00520-008-0535-9.[PubMed][Cross Ref]
39. Saito M, Aogi K, Sekine I, Yoshizawa H, Yanagita Y, Sakai H, et al. Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol. 2009;10:115–124. doi: 10.1016/S1470-2045(08)70313-9.[PubMed][Cross Ref]
40. Ho CL, Su WC, Hsieh RK, Lin ZZ, Chao TY. A randomized, double-blind, parallel, comparative study to evaluate the efficacy and safety of ramosetron plus dexamethasone injection for the prevention of acute chemotherapy-induced nausea and vomiting. Jpn J Clin Oncol. 2010;40:294–301. doi: 10.1093/jjco/hyp169.[PubMed][Cross Ref]
41. Tan L, Liu J, Liu X, Chen J, Yan Z, Yang H, et al. Clinical research of Olanzapine for prevention of chemotherapy-induced nausea and vomiting. J Exp Clin Cancer Res. 2009;28:1–7. doi: 10.1186/1756-9966-28-131.[PMC free article][PubMed][Cross Ref]