Propofol
really works the best for emesis, but it is an anesthetic med and one must never underestimate the apnea power of propofol
Haldol
Haloperidol is as effective as ondansetron for preventing postoperative nausea and vomiting (Canadian Journal of Anesthesia 54:349-354 (2007))
5HT3 Receptor Antagonists
Zofran
4 mg, excellent but very expensive given IV can be used in pregnancy
Back to topBenzamides
Metoclopramide (Reglan)
D2 receptors at low doses, 5HT3 receptors at higher doses. prokinetic agent especially suited for opoid induced delayed gastric emptying At higher
doses, EPS side effects in up to 1/5 of patients. Trimethobenzaminde (Tigan) unknown mechanism, ? indirect D2 blockade
Back to topButyrophenones
stronger D2 receptor affinity with no anticholinergic or antihistamine effects Droperidol 0.625 mg good to excellent Given IV In one study, it was better than reglan or compazine. They used 1.25 dose (AJEM 2006;24:177) Haldol may be as effective as droperidol
Back to topPhenothiazines
avoid in pregnancy, glaucoma and gastric outlet obstruction
Chlorpromazine (Thorazine)
probably as effective as compazine
Perphenazine (Trilafon)
May be more potent
Prochlorpermazine (Compazine)
10 mg good to excellent, given iv
Promethazine (Phenergan)
suppositories, IV or IM, however in my experience, it causes some pain given IV I do not like to use it that way unless put into an IV bag. Probably better IM than IV. Has strong antihistamine effects as well
Back to topAnticholinergics
particularly useful in N/V of vestibular origin
Scopolamine
can be given transdermally
Back to topAntihistamines
have anticholinergic effects as well as H1 blockade
Hydroxyzine (Atarax/Vistaril)
25-50 mg IM or PO, use just like phenergan Dimenhydrinate (Dramamine) for motion sickness Diphenhydramine (Benadryl) for motion sickness Meclizine (Antivert) for motion sickness and possibly vestibular disease | | |
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