Non sedating anti histamine
Evidence-based guidelines16 developed by a committee from the American Academy of Family Physicians, the American Academy of Neurology, and other organizations support the use of intravenous metoclopramide (Reglan) and intravenous, intramuscular, and rectal prochlorperazine (Compazine) as single-agent therapies in patients with acute migraine headaches and nausea.The committee concluded that oral antiemetics and 5-HTBetween 70 and 85 percent of women have nausea during pregnancy, and an estimated 0.5 percent develop hyperemesis gravidarum.17 The pathogenesis of nausea in pregnancy is not completely understood but is thought to be multifactorial.In general, the serotonin antagonists have been shown to be safe, with minimal significant side effects.Headache, diarrhea, and fatigue (the most common side effects) occur independently of dosage and route of administration.1112 Hypersensitivity reactions to these agents occur rarely but have been associated with complications ranging from urticaria to bronchospasm and anaphylaxis.Both antihistamines and anticholinergics can have anticholinergic side effects, including dry mouth, urinary retention, blurred vision, and exacerbation of narrow-angle glaucoma.In general, however, these drugs have few severe adverse effects.Dopamine antagonists block dopamine in the intestines and chemoreceptor trigger zone; indications for these agents are similar to those for serotonin antagonists.
Unlike other forms of nausea, which tend to be mediated by dopamine and serotonin, vestibular system–induced nausea is mediated primarily by histamine and acetylcholine .
Nausea and vomiting are mediated primarily by visceral stimulation through dopamine and serotonin, by vestibular and central nervous system causes through histamine and acetylcholine, and by chemoreceptor trigger zone stimulation through dopamine and serotonin. Antihistamines and anticholinergic agents are most effective in patients with nausea resulting from vestibular and central nervous system causes.
D., Fort Collins Family Medicine Residency Program, Fort Collins, Colorado ROBERT D. D., University of Wyoming School of Pharmacy, Laramie, Wyoming AUSTIN G. D., Fort Collins Family Medicine Residency Program, Fort Collins, Colorado Am Fam Physician. An understanding of the pathophysiology of nausea and the mechanisms of antiemetics can help family physicians improve the cost-effectiveness and efficacy of therapy.
This action subsequently decreases afferent visceral and chemoreceptor trigger zone stimulation of the medullary vomiting center.
Because of their diffuse blockade of serotonin, these agents have become the primary treatment for a variety of causes of nausea.
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Treatment of nausea and vomiting ideally involves correcting the underlying cause.