Updated: 10/28/2019

Other Anti-Nausea Medications

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Snapshot
  • A 45-year-old woman with a history of metastatic sarcoma presents to the infusion center for chemotherapy infusion. She has experienced nausea and vomiting in the past with each infusion, which did not improve with ondansetron. Today, she is told that she can try another medication, aprepitant, which has worked for some patients who could not tolerate ondansetron. This could be given intravenously or by pill. She opts for the intravenous option as her nausea is often debilitating.
Pirenzepine
  • Drugs
    • scopolamine
    • aprepitant
    • dimenhydrinate
    • meclizine
    • promethazine
Anti-Emetics

Scopolamine
Aprepitant
Anti-Histamines
Mechanism of Action 
  • Muscarinic antagonist in the central nervous system
  • Substance P antagonist
  • Blocks neurokinin-1 receptors in the central nervous system
Dimenhydrinate
  • First generation anti-histamine
Meclizine
  • Anti-histamine
  • Also has mild anti-cholinergic effects
Promethazine
  • Anti-histamine
  • Also has dopamine receptor angatonism
Clinical Use
  • Motion sickness
  • Anti-emetic, in the setting of chemotherapy
  • Motion sickness
  • Nausea and vomiting (promethazine)
Adverse effects
  • Dry mouth
  • Drowsiness
  • Dizziness
  • Blurry vision
  • Induces CYP3A4
  • Headache
  • Constipation
  • Drowsiness
  • Anti-cholinergic effects
  • Acute glaucoma
  • Dry mouth
  • Extrapyramidal symptoms (promethazine)
 
 

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