A physiological perspective for utility or futility of alcohol-based hand rub gel against nausea-vomiting: is it P-6 acupoint or transnasal aroma?
Nausea-vomiting is a common and unpleasant phenomenon with numerous underlying mechanisms and pathways that are not always well elucidated. In clinical practice, refractory nausea-vomiting is encountered in several settings. Antiemetic medications may reduce these symptoms but are not always effective in all patients. In the absence of a well-defined optimal strategy for management of nausea-vomiting, the search for better approaches to treat this distressing symptom continues. One of the alternative treatment approaches is a compounded formulation called ABHR gel that is comprised of multiple antiemetic medications and has been shown to be useful for symptomatic relief in some patients with refractory nausea-vomiting. It has been suggested that alternative mechanisms should be explored to explain the perceived efficacy of ABHR gel, because transdermal absorption leading to nil-to-minimal or subtherapeutic blood concentrations of active ingredients does not explain the role of ABHR gel in the treatment of nausea-vomiting. In the current paper, we discuss possible mechanisms that may explain ABHR transdermal gel's efficacy. Compounded ABHR transdermal gel formulation's efficacy in antagonizing nausea-vomiting that has been recently questioned may be explained by alternative mechanisms mediated through the P-6 acupoint stimulation and facial-nasal, cooling-related counterstimulation.
Department of Anesthesiology, Wayne State University, Detroit, MI, USA.
Deepak
D
Gupta
Department of Anesthesiology, Detroit Medical Center, MI, USA.
Ashish
A
Mazumdar
Department of Internal Medicine, Wayne State University, Detroit, MI, USA mstellini@med.wayne.edu.
Michael
M
Stellini
D000279:Administration, Cutaneous; D000438:Alcohols / Q000737:chemistry; D000932:Antiemetics / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D019341:Aromatherapy; D005782:Gels / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D009325:Nausea / Q000628:therapy*; D014839:Vomiting / Q000628:therapy*
D000438:Alcohols; D000932:Antiemetics; D005782:Gels
ABHR transdermal gel; P-6 acupoint; aromatherapy; isopropyl alcohol inhalation; nausea–vomiting; transnasal aroma