What are the medications for nausea?

From the Guidelines

Medications for nausea include metoclopramide, domperidone, 5-HT3 receptor antagonists (e.g., ondansetron, granisetron), neurokinin (NK-1) receptor antagonists (e.g., aprepitant), and phenothiazine antipsychotics (e.g., prochlorperazine, chlorpromazine).

Medication Options

• Dopamine receptor antagonists: metoclopramide, domperidone, prochlorperazine, and haloperidol are commonly used to manage nausea and vomiting 1.
• 5-HT3 receptor antagonists: ondansetron and granisetron are effective in reducing nausea and vomiting, with granisetron available in various forms, including a transdermal patch 1.
• NK-1 receptor antagonists: aprepitant has been shown to improve nausea and vomiting in patients with gastroparesis and may be beneficial in other cases of refractory nausea 1.
• Phenothiazine antipsychotics: prochlorperazine and chlorpromazine can be used to manage nausea and vomiting, although their use is not well-studied in gastroparesis patients 1.

Dosage and Administration

• Metoclopramide: typically started at 10 mg 3-4 times a day, with a maximum dose of 20 mg 4 times a day, although higher doses may increase the risk of cardiac side effects 1.
• Domperidone: recommended starting dose is 10 mg 3 times a day, with a maximum dose of 20 mg 4 times a day, although higher doses should be avoided due to cardiovascular safety concerns 1.
• Ondansetron: available in parenteral and enteral forms, with dosing varying depending on the specific formulation and patient population 1.
• Granisetron: available in various forms, including a transdermal patch, with dosing varying depending on the specific formulation and patient population 1.

Clinical Considerations

• Combination therapy: using multiple antiemetic agents with different mechanisms of action may be beneficial in managing refractory nausea and vomiting 1.
• Opioid-induced nausea: prophylactic treatment with antiemetic agents is recommended, and adding therapies that target different mechanisms of action may be helpful in managing persistent nausea 1.
• Cannabinoids: may be considered for refractory chemotherapy-induced nausea and vomiting, although their use is not well-studied in other contexts 1.

From the Research

Medications for Nausea

The following medications are used to treat nausea:

• Serotonin antagonists 2
• Dopamine antagonists 2, 3
• Specific examples of dopamine antagonists include:
  • Haloperidol 3
  • Olanzapine 3
  • Prochlorperazine 3, 4
  • Metoclopramide 3, 4, 5, 6
• Other antiemetic agents:
  • Droperidol 4, 5
  • Promethazine 4, 5
  • Ondansetron 4, 5, 6

Considerations for Medication Use

When choosing a medication for nausea, considerations include:

• Efficacy of the medication 4, 5, 6
• Potential side effects, such as QTc prolongation, tardive dyskinesia, and extrapyramidal symptoms 3, 4
• Patient factors, such as renal function, hepatic function, and age 3
• Cost and patient preference 5