title: The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting.
abstract: Glucocorticoids, used primarily as anti-allergic and anti-inflammatory drugs, are also effective, alone or combined with other antiemetics, for preventing nausea and vomiting. Dexamethasone, one of the glucocorticoids, has been suggested as a first-line drug for preventing low-level emetogenic chemotherapy- and radiotherapy-induced nausea and vomiting, and in patients with only one or two risks for postoperative nausea and vomiting (PONV). Dexamethasone combined with 5-HT3 or tachykinin NK1 antagonists is also suggested for higher-level emetogenic chemotherapy and radiotherapy and for patients at high risk for PONV. Glucocorticoids may act via the following mechanisms: (1) anti-inflammatory effect; (2) direct central action at the solitary tract nucleus, (3) interaction with the neurotransmitter serotonin, and receptor proteins tachykinin NK1 and NK2, alpha-adrenaline, etc.; (4) maintaining the normal physiological functions of organs and systems; (5) regulation of the hypothalamic-pituitary-adrenal axis; and (6) reducing pain and the concomitant use of opioids, which in turn reduces opioid-related nausea and vomiting.
authors.affiliation: Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Chu
authors.affiliation: Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of Anesthesiology, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chung-Hsi
authors.initials: CH
authors.lastname: Hsing
authors.affiliation: Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Ja-Ping
authors.initials: JP
authors.lastname: Shieh
authors.affiliation: Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chien
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chiu-Ming
authors.initials: CM
authors.lastname: Ho
authors.affiliation: Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan. Electronic address: 400002@mail.chimei.org.tw.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000932:Antiemetics / Q000494:pharmacology* / Q000627:therapeutic use; D003907:Dexamethasone / Q000494:pharmacology* / Q000627:therapeutic use; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism / Q000382:microbiology; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism
chemical_list: D000932:Antiemetics; D005938:Glucocorticoids; D003907:Dexamethasone
keywords: CINV; Dexamethasone; Emesis; Glucocorticoids; PONV; RINV