anti vomiting drugs

1. ANTI EMETICS
PRESENTED BY
ABHILASHA VERMA
LECTURER
JHALAWAR NURSING COLLEGE

2. DEFINITION
“Drugs which prevent or control/suppress
vomiting are known as anti-emetic drugs”

3. CLASSIFICATION
1) Anti cholinergics-
a) Hyosine
b) Dicyclomine
2) Anti histamines-
a) Cyclizine
b) Diphenhyramine
c) Meclozine
d) Promethazine
e) hydroxyzine
3) Neuroleptics-
a) Chlorpromazine
b) Prochlorperazine
c) haloperidol

4. 4) Prokinetic drugs or dopamine antagonist-
a) Metoclopramide
b) Domperidone
c) Cisapride
d) Tegosterod
5) 5HT antagonist-
a) Ondansteron
b) Granisteron
c) Dolasteron
6) Adjuvent anti emetics-
a) Dexamethason
b) Benzodiapines
c) Cannabinoids.

5. DRUG EXAMPLE & DOSES
CATEGORY DRUG NAME DOSE
ANTI HISTAMINE 1) Doxylamine
2) Cyclizine
10 mg Tab
25 mg, 50 mg
ANTI CHOLINERGIC 1) Dicyclomine
2) Hyoscine
40 mg 6 hyly
200-600 mcg SC
NEUROLEPTICS Prochlorperazine
( Stemetil)
5mg, 25 mg tab.
PROKINETICS Metoclopramide
(Perinorm)
10mg tab,
5mg/ 5ml syp,
10mg/2ml inj.
5HT AGONISTS Ondansteron 4 mg , 8mg tab.,
2mg/ml in 2 ml vial

6. MECHANISM OF ACTION
 Anti-cholinergics- They blocks the conduction of nerve
impulses from vestibular part of ear to vomiting center.
 Anti-histamines- They blocks the histamine neurotransmitter
and they act by effect on vomiting center and by producing
sedation.
 Prokinetics ( Dopamine agonist)- They blocks dopamine
neurotransmitter, they promote GIT motility and quicken
gastric emptying .
 5HT anatagonist- They blocks serotonin receptor in CNS and
GIT. Also treat post operative and cytotoxic chemotherapy
induced nausea, vomiting.
 Adjuvent anti-emetics- Increase the anti-emetic effect of
primary anti emetic drugs like ondansterone ,
metoclopramide

7. INDICATION / USES
• 5 HT antagonists are used in management of nausea,
vomiting associated with cancer chemotherapy.
• Anti histamines used mainly for motion sickness and
morning sickness as well as post operative vomiting.
• Metoclopramide is used for NG tube feeding patient and
GERD ( Gastric esophageal reflux disease)
• Anticholinergics are used in travel sickness ( motion
sickness)
• Neuroleptics used in drug induced and post anaesthetic
nausea and vomiting.
• Neuroleptics used only in case of hyperemesis
gravidarum.
• Disease induced vomiting like gastritis, meningitis,PUD.

8. CONTRAINDICATION
• Hypersensitivity to drugs
• Renal impairment ( Reduce dose)
• Metoclopramide contraindicated in suspected
GIT problems.

9. DRUG INTERACTION
• Anti histamine with other CNS depressant drugs
including opioids and sedatives, hypnotic drugs may
cause additive CNS depressants.
• Metoclopramide increase absorption rate of drugs
like asprine, diazepam.
• Metoclopramide reduce digoxin absorption.

10. ADVERSE EFFECTS
• Hypotension
• Constipation
• Dryness of mouth
• Blurred vision
• Acute muscle dystonia ( due to Prochlorperazine)
• Rectal irritation.
• Vertigo ( due to doxylamine)
• Loose stools, gynaecomastism, galactorrhoea. ( due to
Metoclopramide)
• Abdominal upset
• Cardiac arrythemia due to rapid IV injection.
• Sedation.etc.

11. NURSING RESPONSIBILITY
• Assess the patient for nausea, vomiting and fluid- electrolyte
imbalance.
• Advise the patient to take oral anti emetic 1 hour before
exposure to condition causing vomiting like- travel.
• Decrease metoclopramide dose up to 50% of usual
recommanded dose if creatinine clearance is less than 40 ml/
min.
• Instruct the patient to not to consume alcohol while taking
anti emetic drugs.