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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Nausea and Vomiting in 2021: A Comprehensive Update.

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Nausea and vomiting (N/V) treatments are reviewed, highlighting challenges in managing chronic or chemotherapy-induced N/V. Emerging research into N/V pathophysiology offers hope for improved and safer therapeutic interventions.

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Area of Science:

  • Gastroenterology
  • Pharmacology
  • Medical Therapeutics

Background:

  • Nausea and vomiting (N/V) are prevalent medical symptoms.
  • Difficult-to-control N/V, particularly chronic or chemotherapy-induced cases, significantly impairs quality of life and increases healthcare costs.
  • Current pharmacotherapy for N/V often presents inadequate efficacy and significant side effect profiles.

Purpose of the Study:

  • To provide a comprehensive review of current and emerging treatments for nausea and vomiting (N/V).
  • To discuss the pathophysiology, pharmacotherapy, and alternative interventions for N/V management.

Main Methods:

  • Literature review encompassing pathophysiology, pharmacotherapy, immunotherapies, bioelectrical neuromodulation, behavioral and surgical therapies, and complementary medicine for N/V.
  • Analysis of safety concerns and controversies surrounding established N/V pharmaceuticals.

Main Results:

  • Established pharmacotherapies for N/V may be insufficient for certain patient populations.
  • A wide array of interventions are explored, including novel immunotherapies and bioelectrical neuromodulation techniques like gastric electrical stimulation.
  • Behavioral, surgical, and complementary medicine approaches are also considered.

Conclusions:

  • Advancements in understanding N/V pathophysiology are paving the way for more effective therapies.
  • Improved interventions for nausea and vomiting are becoming increasingly available, addressing limitations of traditional treatments.