Physiology and pharmacology of nausea and vomiting |
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| Authors: | Barbara J Pleuvry |
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| Affiliation: | Barbara J Pleuvry B Pharm MSc PhD is a retired Senior Lecturer in Anaesthesia and Pharmacology at the University of Manchester, UK. She has been involved in teaching pharmacology and neuroscience to postgraduates and undergraduates for over 40 years. Her research interests include pain, analgesia, anaesthetic and anticonvulsant drugs. Conflicts of interest: none declared |
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| Abstract: | The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D2, 5-HT3, histamine H1 and neurokinin NK1 receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV). |
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| Keywords: | Anti-emetic drugs emetic drugs nausea and vomiting post-operative nausea and vomiting (PONV) |
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