Pharmacological causes and treatments of nausea and vomiting

Abstract

Extensive investigation has defined neurotransmitter receptor pathways that mediate emesis. Use of prescription and over-the-counter medications can elicit nausea and vomiting by action on these pathways and by nonreceptor mechanisms in previously healthy individuals or can worsen these symptoms in patients with preexisting disorders with nausea and vomiting. Medication-induced nausea and vomiting has been best characterized for opiates, cancer chemotherapy, and for agents given during surgery. Conversely, a number of medications with central and peripheral antiemetic effects, actions to promote gastrointestinal propulsion, or blunt gut sensory nerve function have been identified as effective in decreasing nausea and vomiting. Selection of the appropriate antiemetic or antinausea drug depends on several factors including the clinical setting, the side effects of the drug being considered, and potential adverse interactions with other agents being taken by the patient. Research is ongoing into new pharmaceuticals that act by known receptor mechanisms but which offer other pharmacologic advantages. Because most available medications provide superior reduction of vomiting versus nausea, further study of therapies specifically targeting control of nausea is warranted.