Antiemetics

Prophylactic for chemotherapy-induced nausea and vomiting, also for brain filiae in metastatic malignant melanoma.

• For the treatment of nausea and vomiting, the following pharmacological classes of substances are used:
• H1 antihistamines
• 5-HT3 antagonists
• Neuroleptics.
• Gastrointestinal movement promoting substances:
• Herbal remedies
• Homeopathic remedies
• H1 antihistamines.
• Antihistamines: Antihistamines block the effects of the body's own substance histamine. The different effects of histamine result from the binding of the substance to different receptors, of which three types are currently known. For the treatment of nausea and vomiting, the H1 receptors are important, which are blocked by the H1 antihistamines.
• The _H1 antagonists are divided into 1st and 2nd generation drugs. Of importance here is that the H1 antihistamines of the 1st generation have a sedative effect, i.e. they make you tired. This effect is exploited when some H1 antihistamines are administered as sleeping pills. When the substances are used as a remedy against nausea and vomiting, the tiring effect is sometimes a desirable side effect.
• The following H1 antihistamines are used as remedies against nausea and vomiting:
• Dimenhydrinate
• Meclizine
• Diphenhydramine.
• Serotonin antagonists (5-HT3-antagonists): 5-HT3-antagonists bind to serotonin receptors and thus prevent the effects of the body's own substance serotonin. They are a relatively newly developed class of substances that are very effective against vomiting caused by treatment with cytostatic drugs or during radiotherapy. For this reason, 5-HT3 antagonists are often used as an accompanying treatment in the context of tumour therapy. The substances are characterised by their good effectiveness against vomiting which occurs early, i.e. within the first 24 hours after administration of the cytostatic drug. In the case of vomiting occurring later, i.e. two to three days after the application of the tumour drug, the 5-HT3 antagonists are generally no longer sufficiently effective. For the treatment of nausea and vomiting can be used:
• Granisetron
• Ondansetron
• Tropisetron
• Dolasetron.
• Neuroleptics: Neuroleptic drugs are often used in antiemetic therapy to treat nausea and vomiting, in particular:
• Sulpiride
• Triflupromazine
• Haloperidol
• Perphenazine.
• Gastrointestinal movement stimulants, prokinetics: nausea and vomiting can also be treated by accelerating gastric emptying and small intestinal passage. This shortens the time food stays in the upper gastrointestinal tract and reduces the effects of stimuli that cause nausea and vomiting. The following substances promote gastrointestinal movement:
• Metoclopramide
• Bromoprid
• Cisapride
• Domperidone
• Herbal remedies.
• In "folk medicine", herbal remedies are used relatively frequently for complaints in the digestive tract and thus also for nausea and vomiting, although the use of the respective plants or parts of plants is handled differently. There are official recommendations for ginger root.
• Homeopathic remedies: As homeopathic remedies for nausea and vomiting the following medicines can be used:
• Hervertigon Tbl. or Hervertigon injection solution
• Vertigo-Hervert Tbl. (pharmacy-only, but not prescription and therefore suitable for self-medication).
• Cocculus Oligoplex Liquidum (pharmacy-only, but not prescription and therefore suitable for self-medication).

Overview of the most frequently used antiemetics