title: Practical selection of antiemetics.
abstract: An understanding of the pathophysiology of nausea and the mechanisms of antiemetics can help family physicians improve the cost-effectiveness and efficacy of therapy. Nausea and vomiting are mediated primarily by visceral stimulation through dopamine and serotonin, by vestibular and central nervous system causes through histamine and acetylcholine, and by chemoreceptor trigger zone stimulation through dopamine and serotonin. Treatment is directed at these pathways. Antihistamines and anticholinergic agents are most effective in patients with nausea resulting from vestibular and central nervous system causes. Dopamine antagonists block dopamine in the intestines and chemoreceptor trigger zone; indications for these agents are similar to those for serotonin antagonists. Serotonin antagonists block serotonin in the intestines and chemoreceptor trigger zone, and are most effective for treating gastrointestinal irritation and postoperative nausea and vomiting. Complementary and alternative therapies, such as ginger, acupressure, and vitamin B6, have variable effectiveness in the treatment of pregnancy-induced nausea.
authors.affiliation: Fort Collins Family Medicine Residency Program, Fort Collins, Colorado 80524, USA. flakza@pvhs.org
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Flake
authors.forename: Robert D
authors.initials: RD
authors.lastname: Scalley
authors.forename: Austin G
authors.initials: AG
authors.lastname: Bailey
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D002493:Central Nervous System Diseases / Q000150:complications; D002648:Child; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000627:therapeutic use; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications; D008297:Male; D009325:Nausea / Q000188:drug therapy* / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D012702:Serotonin Antagonists / Q000627:therapeutic use; D014839:Vomiting / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000932:Antiemetics; D018680:Cholinergic Antagonists; D018492:Dopamine Antagonists; D006634:Histamine H1 Antagonists; D012702:Serotonin Antagonists