Nausea / Vomiting

VOMIT acronym (see Fast Facts)

Vestibular

  • Receptors:  Cholinergic, Histaminic
  • Rx : Anticholinergic, Antihistaminic
    • Scopolamine patch, Promethazine

Obstruction (Constipation): non structural :

  • Receptors : Cholinergic, Histaminic, likely  5HT3
  • Rx: Stimulate myenteric plexus
    • Senna products

Motility dysfunction of gut

  • Receptors : Cholinergic, Histaminic, 5HT3, 5HT4
  • Rx : Prokinetics  stimulating , 5HT4 receptors
    • Metoclopramide

Infection, Inflammation

  • Receptors : Cholinergic, Histaminic, 5HT3, Neurokinin 1
  • Rx : Anticholinergic,  Antihistaminic, 5HT3 antagonists, Neurokinin 1 antagonists
    • Promethazine (e.g. for labyrinthitis), Prochlorperazine
    • NK1 antagonist : APREPITANT oral, use in chemotherapy induced N/V, use with DEXAMETASONE & 5 HT3 antagonist

Toxins stimulating the chemoreceptor trigger-zone in the brain such as opioids

  • Receptors : Dopamine 2, 5HT3
  • Rx : Antidopaminergic,  5HT3 Antagonists
    • Prochlorperazine, Haloperidol, Ondansetron

 

Promethazine (Phenergan) is most useful for vertigo and gastroenteritis due to infections and inflammation. Prochlorperazine  ( Compazine) is preferred for opioid related nausea.

Further reading:  see : Fast facts