Fast Fact and Concept #005; Treatment of Nausea and Vomiting

2nd Edition

Author(s): James Hallenbeck, MD

By understanding the pathophysiology of nausea and targeting antiemetics to specific receptors, therapy can be optimized and side effects minimized. An easy way to remember the causes of vomiting is the VOMIT acronym. In the table below receptors involved in different types of nausea are highlighted using this acronym. Blockade of these receptors allows rational, focused therapy.

Cause - Vestibular

• Receptors Involved - Cholinergic, Histaminic
• Drug Class Useful - Anticholinergic, Antihistaminic
• Drug Examples - Scopolamine patch, Promethazine

Cause - Obstruction of Bowel caused by constipation

• Receptors Involved - Cholinergic, Histaminic, 5HT3
• Drug Class Useful - Stimulate myenteric plexus
• Drug Examples - Senna products

Cause - DysMotility of upper gut

• Receptors Involved - Cholinergic, Histaminic, 5HT3
• Drug Class Useful Prokinetics stimulate 5HT4 receptors
• Drug Examples - Metoclopramide

Cause - I nfection, Inflammation

• Receptors Involved - Cholinergic, Histaminic, 5HT3, Neurokinin 1
• Drug Class Useful - Anticholinergic, Antihistaminic, 5HT3 antagonists,
• Neurokinin 1 antagonist
• Drug Examples - Promethazine

Cause - T oxins stimulating the CTZ in the brain such as Opioids

• Receptors Involved - Dopamine 2, 5HT3
• Drug Class Useful - Antidopaminergic, 5HT3 Antagonist
• Drug Examples - Prochlorperazine, Haloperidol, Ondansetron

Note: Phenergan and Compazine are very different drugs. Phenergan is useful for vertigo and gastroenteritis due to infections and inflammation. Compazine is preferred for opioid related nausea.

Note: There is no good evidence supporting the use of lorazepam as a sole agent for nausea. Sedated patients are more prone to aspiration.

References

1. Glare P et al. Systemic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer.
2. Hallenbeck J. Palliative Care Perspectives. New York: Oxford University Press; 2003. 75-86. cancer. Support Care Cancer 2004; 12:432-440

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Hallenbeck, J. Fast Fact and Concepts #5: Causes of Nausea and Vomiting (V.O.M.I.T.). August 2005, 2nd Edition. End-of-Life / Palliative Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 2/2000; August 2005, 2nd Edition.

Purpose: Teaching

Audience(s)

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Non pain symptoms & syndromes