Therapeutic target
Elimination of symptomatology
Therapy recommendations
- Symptomatic therapy with antiemetics (drugs for nausea and vomiting):
- Kinetoses (motion sickness):
- Scopolamine (anticholinergics), by means of transdermal therapeutic system or dimenhydrinate (antihistamines).
- Domperidone (dopamine antagonists).
- Kinetoses (motion sickness):
- Prophylaxis of cytostatic drug-induced nausea and vomiting (synonym: chemotherapy-induced nausea and vomiting, CINE), postoperative nausea/vomiting:
- Serotonin antagonists (synonym: 5-HT receptor antagonists; setrons), eg, dolasetron (off-label), granisetron, ondansetron, palonosetron Dosing Instructions: 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:
- Aprepitant: antiemetic prophylaxis on day 1 once 125 mg 1 h before the start of chemotherapy, on days 2 and 3 each 80 mg p. o.
- Fosaprepitant: day 1: 150 mg (no further administration necessary on subsequent days).
- Netupitant: 300 mg netupitant/0.5 mg palonosetron (combination preparation) once on day 1.
- Rolapitant: day 1: 180 mg (no further administration necessary on subsequent days).
- Glucocorticoids: dexamethasone 8-20 mg once (if necessary, also 8 mg daily on day 2 + 3).
- A large number of studies show 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 due to chemotherapy: e.g., dronabinol (trans-delta-9-tetrahydrocannabinol; THC), dosage: 2 x 2.5 mg (if necessary, additive to a common antiemetic)
- In addition to symptomatic therapy, the underlying disorder should always be treated simultaneously.
- Hyperemesis gravidarum (nausea of pregnancy) see below the disease of the same name.
- See also under “Further therapy“.
