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anti-emetic

Notes: 1) hydration is probably the most effective antiemetic [1] 2) droperidol is better than placebo [1], but metoclopramide & prochlorperazine are NOT 3) high-emetic-risk chemotherapy - cisplatin or anthracycline combined with cyclophosphamide - 4 drug combination of: - substance P receptor antagonist (aprepitant or netupitant) - 5-HT3 receptor anagonist (ondasetron or palonsetron) - dexamethasone - olanzapine - continue dexamethasone & olanzapine on days 2-4 [3] 4) moderate-emetic-risk chemotherapy - carboplatin, oxaliplatin - 3 drug combination of - substance P receptor antagonist (aprepitant or netupitant) - 5-HT3 receptor anagonist (ondasetron or palonsetron) - dexamethasone [3] 5) breakthrough nausea/vomiting - intravenous palonsetron + dexamethasone [NEJM Knowledge+,5,6] - olanzapine [3] 6) aprepitant, lorazepam, a dopamine receptor antagonist, dronabinol, or nabilone in patients with continued nausea/vomiting despite adequate hydration & olanzapine [3] 7) high-emetic risk radiation therapy - 2 drug combination before each fraction & on the day after each fraction - 5-HT3 receptor anagonist (ondasetron) - dexamethasone [3] 8) concurrent radiation & chemotherapy - treat for highest emetic risk [3] 9) children: - 3 drug combination of - substance P receptor antagonist (aprepitant) - 5-HT3 receptor anagonist (ondasetron) - dexamethasone [3] - ondansetron + dexamethasone if aprepitant contraindicated - palonosetron + aprepitant if dexamethasone contraindicated

Specific

acepromazine; acetylpromazine (Atravet, Acezine 2) amisulpride (Solian, Deniban, Barhemsys) aprepitant (Emend) dimenhydrinate (Dramamine) diphenhydramine (Benadryl, Alledryl, Allergival) dolasetron (Anzemet) doxylamine (UniSom) dronabinol (Marinol) droperidol (Inapsine) fosaprepitant (Emend) granisetron (Kytril, Sancuso) intravenous anti-emetic combination maropitant (Cerenia) meclizine (Antivert) metoclopramide (Reglan, Metozolv ODT) nabilone (Cesamet) netupitant; fosnetupitant ondansetron (Zofran) palonosetron (Aloxi) phosphorylated carbohydrates (Emetrol) prochlorperazine (Compazine, Stemetil, Novamin, Buccastem) promethazine (Phenergan, Farganesse) rolapitant (Varubi) scopolamine (Transderm Scop, Hyoscine) suppository anti-emetic combination (BRD) thiethylperazine (Torecan, Norzine, Toresten) trimethobenzamide (Tigan) tropisetron (Navoban, Setrovel)

General

gastrointestinal agent

References

  1. Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. Am J Emerg Med. 2006 Mar;24(2):177-82. PMID: 16490647
  2. Prescriber's Letter 13(10): 2006 Antiemetics Used for Postoperative Nausea and Vomiting Detail-Document#: 221004 (subscription needed) http://www.prescribersletter.com
  3. Anello J, Feinberg B, Heinegg J et al Antiemetics in Adults and Children Guidelines on antiemetics by the American Society of Clinical Oncology. Medscape: New Guidelines and Recommendations, August 2017. http://reference.medscape.com/viewarticle/884517
  4. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021
  5. Hesketh PJ, Kris MG, Basch E et al Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017 Oct 1;35(28):3240-3261. PMID: 28759346 Review.
  6. Navari RM, Aapro M. Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting N Engl J Med 2016;374:1356-67. PMID: 27050207 https://www.nejm.org/doi/pdf/10.1056/NEJMra1515442