From the Guidelines
Anticholinergics directly alleviate nausea by targeting the muscarinic acetylcholine receptors in the gastrointestinal tract and the central nervous system, which play a role in regulating nausea and vomiting 1.
Mechanism of Action
- Anticholinergics, such as scopolamine, work by blocking the action of acetylcholine, a neurotransmitter that stimulates the muscles in the gastrointestinal tract and can trigger nausea and vomiting.
- By reducing the activity of acetylcholine, anticholinergics can help to decrease the contractions of the stomach and intestines, which can contribute to nausea and vomiting.
Clinical Use
- Anticholinergics are often used in combination with other antiemetic agents, such as dopamine receptor antagonists and 5-HT3 receptor antagonists, to provide a synergistic effect in managing nausea and vomiting 1.
- The use of anticholinergics, such as scopolamine, has been shown to be effective in managing opioid-induced nausea and vomiting, as well as chemotherapy-induced nausea and vomiting 1.
Important Considerations
- Anticholinergics can have side effects, such as dry mouth, blurred vision, and constipation, which should be monitored and managed accordingly.
- The use of anticholinergics should be individualized based on the patient's specific needs and medical history, and should be used in conjunction with other antiemetic agents as needed 1.
From the Research
Mechanism of Anticholinergics in Alleviating Nausea
- Anticholinergics are one of the classes of drugs that alleviate the symptoms of nausea and vomiting, either prophylactically or acutely 2.
- The distribution of muscarinic binding sites in the dorsal vagal complex of the rabbit medulla oblongata is different from that in the cat, which may have implications for the identification of the site of action of anticholinergic, antiemetic drugs 2.
- Nausea and vomiting are mediated primarily by visceral stimulation through dopamine and serotonin, by vestibular and central nervous system causes through histamine and acetylcholine 3.
- Antihistamines and anticholinergic agents are most effective in patients with nausea resulting from vestibular and central nervous system causes 3.
Role of Anticholinergics in Treating Nausea
- Anticholinergics are used in combination with other antiemetic drugs to treat vomiting induced by cytotoxic drugs 4.
- The treatment of nausea and vomiting involves targeting the pathways mediated by dopamine, serotonin, histamine, and acetylcholine 3, 4.
- Dopamine antagonists, which include antipsychotics, can also act as anticholinergics and are used to treat nausea, psychosis, and acute migraine 5.
- Anticholinergics may be used to prevent migraine when taken before an attack, especially in patients with nausea and vomiting 5.