Nausea (Sickness): Drug Therapy

Therapeutic target

Elimination of symptomatology

Therapy recommendations

• Elimination of the underlying disorder
• Symptomatic therapy: antiemetics (depending on the indication):
  • Kinetoses (motion sickness):
    • Scopolamine (anticholinergics), as a transdermal therapeutic system.
    • Dimenhydrinate, diphenhydramine, meclozine (antihistamines).
  • Domperidone (dopamine antagonists) antiemetic and increase gastrointestinal transit.
• Cytostatic-induced nausea and vomiting (synonym: chemotherapy-induced nausea and vomiting, CINE), postoperative nausea/vomiting:
  • Prophylaxis
    • Serotonin antagonists (synonym: 5-HT receptor antagonists; setrons), e.g., dolasetron (off-label), granisetron, ondansetron, palonosetron Dosage information: Administration should be approximately 30-60 min before the administration of the chemotherapeutic agent.
    • Neurokinin antagonists (synonym: NK1 receptor antagonists): aprepitant (i.v.), netupitant (oral), fosaprepitant (i.v.), rolapitant (oral)Dosage information: see below.
    • Glucocorticoids: dexamethasone 8-20 mg once (fggf. also 8 mg daily on day 2 + 3).
  • Therapy of breakthrough CINE
    • Atypical neuroleptic: olanzapine; dosage: 5-10 mg orally once daily (for 3 days).
    • Benzodiazepine: lorazepam; dosage: 0.5-2 mg orally/intravenously/as prescribed every 6 h
    • Glucocorticoids: dexamethasone; dosage: 12 mg orally/intravenously once daily.
    • A large number of studies demonstrate that cannabinoids are more effective than common antiemetics (such as phenothiazines (prochlorperazine) and dopamine antagonists (such as metoclopramide)) in the treatment of nausea and vomiting resulting from chemotherapy: e. For example, dronabinol (trans-delta-9-tetrahydrocannabinol; THC), dosage: 2 x 2.5 mg (additive to a common antiemetic, if necessary)Cannabinoids are now considered a backup medication for cytostatic-induced nausea and vomiting.
  • Therapy for breakthrough or refractory CINE.
    • See below Breakthrough CINE
• Hyperemesis gravidarum (nausea of pregnancy): see below the disease of the same name.
• See also under “Further therapy”

Cytostatic drug-induced nausea and vomiting

A large number of studies demonstrate that cannabinoids are more effective than commonly used antiemetics (such as phenothiazines (prochlorperazine) and dopamine antagonists (such as metoclopramide)) in the treatment of nausea and vomiting resulting from chemotherapy (synonym: chemotherapy-induced nausea and vomiting):

• Z. For example, dronabinol (trans-delta-9-tetrahydrocannabinol; THC), dosage: 2 x 2.5 mg (additive to a usual antiemetic, if necessary).

Phytotherapeutics

• Ginger

Supplements (dietary supplements; vital substances)

Suitable dietary supplements should contain the following vital substances:

• Vitamins (niacin (vitamin B3)* , pantothenic acid (vitamin B5)* ).
• Minerals (sodium* * , potassium* * , magnesium* * )
• Other vital substances (coenzyme Q 10)

Legend:* Deficiency symptoms* * Risk groups.

Note: The listed vital substances are not a substitute for drug therapy. Dietary supplements are intended to supplement the general diet in the particular life situation.