The 9 best remedies for vomiting

*Editor’s Review of the Best. About the selection criteria. This material is subjective, not an advertisement and is not a guide to purchase. It is necessary to consult with a specialist before buying it.

Despite the fact that nausea and vomiting is a very distressing and unpleasant symptom, the rating of drugs with antiemetic action will be quite poor. If you consider remedies for headache, for arterial hypertension or for the treatment of pneumonia, you can not only choose two or three dozen drugs, but combine them into different groups. It is possible to combine anti-emetics into groups, but there are probably not even a dozen original remedies. General characteristics of the antiemetic group here.

Although the cause of nausea and vomiting may be manifold, this symptom requires few medications. Vomiting can occur with dizziness, due to neurosis or stress, motion sickness, flying on airplanes, and as a side effect of medications, such as in cancer patients during chemotherapy.

The reason is that nausea and vomiting, or just vomiting without nausea when antiemetics are prescribed, is almost never seen as a symptom of intoxication and inflammation. And that is what most often causes these symptoms!

If vomiting accompanies acute poisoning, intestinal infection, this symptom disappears when the underlying disease is treated, and antiemetics are not needed. In meningitis, due to irritation of the meninges and the vomiting center of the brain, there is the so-called brain vomiting, without nausea. In this case, the unsuspecting patient suddenly spews a powerful fountain of vomit without any warning to the body, without the slightest feeling of nausea. Anti-emetics are also not prescribed for meningitis, because once the inflammation on the meninges has subsided, the vomiting disappears on its own. Therefore, antiemetics fight the gag reflex, and their point of application is almost always the different links of the arc of this reflex.

What antiemetics affect?

Still, an anatomical and physiological approach is very important for the development of various antiemetics. They can affect a wide variety of application points:

For example, in gastroenterology, when nausea and vomiting are due to irritation of the inflamed stomach wall, local anesthetics, such as novocaine, anesthesin, and various coagulants and astringents can be used. An example of such an antiemetic drug can be considered Almagel A, but here we will not consider it, it was described in detail in the material on the treatment of gastritis.

1. Very effective from vomiting drugs that reduce the excitability of the vomiting center in the brain, and excitability of the trigger, or trigger chemoreceptor zone. Vomiting trigger zones are due to the influence of muscarinic, serotonin, dopamine, and H1-histamine receptors. If they are blocked, the vomiting process is not realized;
2. Serotonin receptors will be particularly important for the development of vomiting. They are affected by, for example, ondansetron, used in oncology, when nausea and vomiting are caused by the effects of antitumor drugs that can not be canceled. The ability to induce nausea and vomiting in chemotherapy drugs is called emetogenicity. From the Latin word emesis, which means “vomiting”. This is why antiemetic drugs are also called anti-emetics, or anti-emetics;
3. Cerucal or metoclopramide has a similar effect, inhibiting these receptors and simultaneously blocking dopamine receptors in the brain;
4. Cholinolytics, as well as first-generation antihistamines, and especially such drugs as dimedrol, that is diphenhydramine, as well as promethazine, aka Pipolfen, have a pronounced antiemetic effect.
5. Many neuroleptics, such as haloperidol, trifluoperazine, etaperazine, etc., have an antiemetic effect.

Warning! Antiemetics are strictly prohibited for acute poisoning, intestinal infections, alcohol intoxication and similar conditions, when vomiting cleanses the body and removes alcohol and microbial toxins from the stomach. The only exceptions would be acute radiation exposure and radiation sickness.

This list includes the most effective and popular products for suppressing the gag reflex and reducing the unpleasant feeling of nausea. Each drug has an international nonproprietary name (INN), which is placed in front, after the serial number. Substances are listed in parentheses, only in the form of trade names of various manufacturing companies. As a rule, the first number goes to the most expensive, usually original drug, and then, if available, – commercial copies, or trade names of drugs.

This list is not an advertisement or an invitation to sell. All medicines must be prescribed by a physician in accordance with the diagnosis, indications and contraindications. All information about these drugs is publicly available and taken solely from the official instructions for use. Also drug registry, RLS, /.

For all drugs the current price range is given for pharmacies of all forms of ownership on the territory of the Russian Federation for February 2021. All listed medications are recommended for relief of symptoms of nausea and vomiting by national and international clinical guidelines, and relevant treatment protocols in gastroenterology, hematology, oncology, radiation therapy, otoneurology, ENT diseases – where nausea and vomiting is an unpleasant side symptom of disease, or a side effect of treatment.

Rating of the best remedies for vomiting

Domperidone (Motilium, Motililac, Domstal, Motiject, Passazhiks)

Rating: 4.9

The active ingredient is domperidone, it blocks the dopamine receptors that exist in different parts of the central nervous system. Motilium is indicated for the treatment of chronic esophageal, intestinal and stomach disorders accompanied by belching, heartburn, various symptoms of gastric dyspepsia – nausea, vomiting and feeling of overflow in the stomach area.

Motilium should be taken one tablet half an hour before meals, and if necessary before bedtime. Each tablet contains 10 mg domperidone, the maximum daily dose is 8 tablets for adults. Produces Motilium pharmaceutical company Janssen Silag, and the cost of one pack of 30 pills is on average 670 rubles. The cheapest analogue of Motilium is considered the domestic domperidone, which is produced by Ozon. The average cost of a pack is about 80 rubles.

Advantages and disadvantages

The advantage of Motilium is its fairly high effectiveness, with small urges to vomiting, and with mild nausea, sometimes 1 or 2 tablets a day is enough. On the other hand, there are also contraindications. These include gastrointestinal bleeding, severe liver dysfunction, prolactin-secreting pituitary tumor, and phenylketonuria. But if all indications and contraindications are taken into account, this medicine will be indispensable in the symptomatic treatment of nausea and vomiting.

Metoclopramide (Cerucal, Perinorm, Reglan, Ceruglan)

Rating: 4.9

The active ingredient in cerucal is metoclopramide. It acts on the same dopamine receptors as domperidone and is also their central blocker. Cerucal is indicated for use in conditions such as acute gastritis with a feeling of nausea, a condition of pylorospasm, when food lingers in the stomach, and its atony. Cerucal is used by injection for intestinal obstruction after surgery, for heartburn, gastroesophageal reflux, for nausea and vomiting in patients in the acute period of a stroke, and also for successful diagnostic techniques, for example, before esophagogastroduodenoscopy.

Take Cerucal one tablet half an hour before a meal, the average dose for adults is one tablet three or four times a day, but no more than 6 tablets a day. Cerucal is produced by the Croatian pharmaceutical company Pliva. The cost of a pack of 50 tablets (10 mg each) is 120 rubles on the average.

Advantages and disadvantages

A big plus of Cerucal is the possibility of long-term therapy, which can be two, three or more months, but no more than six months. Cercurcal may also be used as adjunctive therapy to treat cytostatics such as Azathioprine, Cyclophosphamide, etc. to even out their side effects. The advantage of Cerucal will be the availability of an injectable form, which quickly helps either to eliminate nausea or prevent it, for example, during invasive studies.

Ondansentron (Zofran, Latran, Emetron, Emeset, Setronon, Domegan, Ondasol)

Rating: 4.8

It is a modern antiemetic medication produced by the well-known company Novartis, Switzerland. The active ingredient is ondansetron, a xerotonin receptor antagonist. It is known that medications for treatment of cancer and cytostatics cause increased concentration of serotonin in the central nervous system and it is able to stimulate the vomiting center through the parasympathetic system. Ondansentron, by blocking receptors, inhibits the gag reflex arc.

Zofran is shown mainly as concomitant therapy in patients receiving cytostatics and chemotherapy drugs, as well as those undergoing radiation therapy. Other indications would be various postoperative conditions when the patient is bothered by nausea and vomiting, and this often occurs not only after gastrointestinal surgery, but also when the effects of general anesthesia are gradually reduced. It comes in many forms: parenterally, as a snortable tablet, and in the form of a strawberry-flavored syrup. Each tablet contains 4 mg or 8 mg of the active ingredient, and no more than 4 8 mg tablets may be taken per day. The first tablet is taken one hour before the chemotherapy session.

The cost of absorbable pills is quite high. A pack of only 10 Zofran 8 mg tablets costs an average of 2100 rubles. But there are also more affordable analogues. For example, ondansetron, produced by the Israeli company Teva costs only 306 rubles for the same package.

Advantages and disadvantages

Since this drug is a serious one, it should not be used by pregnant women, during lactation and in children under two years of age. Side effects include a variety of allergic reactions, dry mouth, chest pain, headache, and fever. Nevertheless, the effectiveness of this drug is so high that even with high-dose chemotherapy, in which such side effect as nausea occurs almost in 100% of cases, ondansetron allows to significantly improve the patient’s quality of life during this difficult treatment.

Note: There is an even more specific antiemetic from this group, this is granisetron, the original drug is Kitril. It produces an even stronger antiemetic effect, and affects only those serotonin receptors that are responsible for the gag reflex. This drug has much higher efficacy and safety, but the cost is even higher. One pack of domestic granisetron, which is obviously cheaper than all foreign medications, and even less so than original ones, costs 5000 rubles for a package of only 10 pills. The cost of the original medication Kitril is anyone’s guess.

Interested readers are referred to the article in the journal “Practical Oncology”. Although this issue is from 2002, but the article by M.m. Konstantinova from St. Petersburg Medical Academy of Postgraduate Education gives a good overview of modern pharmaceutical groups of drugs used in oncology, including antiemetics.

Tropisetron (Tropindol, Navoban)

Rating: 4.8

Tropisetron is a domestic drug that is produced by Veropharm. This medicine is available in capsules and in a solution for intravenous injection. This drug also successfully blocks the central serotonin receptors and is a good antiemetic. It is indicated to relieve these symptoms in the background of cancer control, in patients who receive chemotherapy.

It is also used in the postoperative period, in abdominal and gastric surgery, and in diaphragm surgery. It is clear that if in the early postoperative period the patient develops uncontrollable vomiting, the freshly placed stitches on the stomach, intestines, diaphragm or esophagus, can simply separate, and vomiting must be fought after surgery in every possible way, and even in excess. This drug should be prescribed in individual dosage, depending on the severity of the vomiting threat. Capsules are not always available, but a single ampule of 5 ml will cost about 1,200 rubles.

Advantages and disadvantages

The drug has side effects such as headaches, abdominal discomfort, loose stools or constipation, hypersensitivity reactions, collapse, or even fainting. Tropindol is contraindicated in pregnant and lactating women, persons with hypersensitivity to serotonin receptor blockers, in other cases described in the instructions. The drug reliably blocks nausea and vomiting, of course, the main disadvantage is its cost.

Promethazine (Pipolfen, Diprazine)

Rating: 4.8

Pipolphen, or Diprazine is a drug against allergies, it ranks with Dimedrol, Fencarol, Diazolin, Suprastin and Tavegil. However, it is promethazine that has the most pronounced, both sedative and anti-nausea and antiemetic properties. In this case, you can buy, of course, only by doctor’s prescription, Pipolfen manufactured by the Hungarian company Egis, at a decent price: for a pack of 10 ampoules you will have to pay from 930 to 1400 rubles.

The drug blocks histamine H1 receptors, but it is the leader of all first-generation antihistamines in terms of sedative and antiemetic action. These effects begin to develop as early as 20 to 30 minutes, and can last from 6 to 12 hours. Of course, Pipolfen is primarily indicated as an emergency remedy to relieve various rather severe allergic manifestations. These include hay fever and Quincke’s edema, generalized urticaria and bronchoobstruction, allergic dermatitis, and so on.

Pipolphen is prescribed for antiemetic purposes both in gastroenterology and anesthesiology. With Pipolphen is not only used to calm down before surgery (premedication), but also to prevent and treat nausea and vomiting associated with anesthesia and surgery. The drug for adults can not be taken more than 75 mg at once, and not more than 500 mg per day. When administered intramuscularly, the single dose is 50 mg, the daily dose is 250 mg.

Advantages and disadvantages

It is very important that for the same purpose Pipolfen can also be prescribed for children, starting from the age of two months. Like other first-generation antihistamines, in addition to pronounced sedation, the drug causes symptoms related to its effect on cholinoreceptors. It is dry mouth and tendency to constipation, drowsiness and dizziness, impaired coordination of movements, tachycardia, delayed urination, and increased intraocular pressure, which can be dangerous in the presence of closed-angle glaucoma.

We will not list contraindications, because Pipolphene and its analogues are strictly prescription, and if it is needed and the doctor considers it necessary, this prescription will be written. Pipolphene are among the powerful drugs, and when used concomitantly, it significantly enhances the effects of opioids, sleeping pills, and local anesthetics. The disadvantage is its relatively short duration of action, and the need to prescribe it several times a day.

Aprepitant (Emend)

Rating: 4.8

This antiemetic drug refers to neurokinin receptor antagonists (NK1). The drug is highly selective and selective, and binds to these receptors 3,000 times more actively than other receptors. Its purpose is to stop nausea and vomiting in the background of chemotherapy in oncology. The drug is able to prevent the acute and delayed phase of vomiting that usually develops on the administration of an anticancer drug such as cisplatin.

The drug is prescribed exclusively in conjunction with antitumor drugs that are highly or moderately emetogenic. It is used according to specific regimens, depending on the days of chemotherapy. This medication will be prescribed by the attending oncologist, and for obvious reasons, there is no need to give a chart here.

Advantages and disadvantages

This remedy is not cheap, a pack of only three capsules (Merck Sharp and Dome, USA), will cost from 5,500 to 7,000 rubles. To be fair, you only need to take Emend for 3 days, and that amount may be enough, but it is still too expensive for many populations.

There are also side effects, of which hiccups, increased liver enzyme activity, constipation, headache, and decreased appetite (although decreased appetite may well be attributed to the very toxic chemotherapy) were the most common. But in any case, Emend can be considered well tolerated, because the frequency of side effects did not exceed one case in 20, and it was hiccups that occurred most often, (4.6%). Of the contraindications, consider severe hepatic insufficiency, as well as simultaneous use with some other drugs, such as pimozide, astemizole and terfenadine. It has not been tested for safety or effectiveness in children. In the case of an overdose of the drug, there was an onset of drowsiness and headache, but without consequences.

Here is another great document from a specialist at the N. N. Oncology Center. n. Blokhin Russian Academy of Medical Sciences, N. v. Zhukov, devoted to recommendations for antiemetic therapy. This article was posted in the journal “Oncourology”, № 4, 2006, but it has not lost its relevance. Link here:

download

df/327168912.pdf

Perphenazine (Etaperazine)

Rating: 4.7

Etaperazine, produced by the domestic company Tatkhimfarmpreparaty, may well be considered one of the budget and cheap antiemetics: the price for a pack of 50 tablets does not exceed 380 rubles. But, alas! It is also a strictly prescription drug. The drug refers to neuroleptics; it is a pronounced blocker of dopamine receptors in the vomiting trigger zone. It also blocks the vagus nerve, which runs through many organs of the gastrointestinal tract and is involved in the formation of the gag reflex.

The medication is commonly used in psychiatry: for agitation, schizophrenia and neurosis, tension and fear. It relieves skin itching well and can also be used to treat nausea and vomiting of various etiologies. With antiemetic purpose it is used in dosage from 4 to 80 mg, but no more than 400 mg per day. In the case of intramuscular administration, the drug is limited to 30 mg per day, and in the case of intravenous administration, no more than 5 mg.

Advantages and disadvantages

The advantage of etaperazine is its low cost, while the disadvantage is that it belongs to neuroleptics. This necessitates a strict prescription and causes side effects common to neuroleptics. It is drowsiness, various extrapyramidal reactions, including parkinsonian type, occasionally – cholestatic jaundice, reduction of granulocytes in blood plasma.

Its anticholinergic effect causes dry mucous membranes, thickening of tracheobronchial secretion, accommodation disorders, increased intraocular pressure, constipation and difficulty in urination. This is the reason for its significant limitation in its use as an anti-emetic drug. It should not be used in pregnant and lactating women, with a high risk of pneumonia, chronic bronchitis and bronchiectatic disease, because the thickening of sputum can cause its infection, in systemic neurological diseases of the brain and spinal cord, and so on. But in some cases, etaperazine with a short course can be used as an antiemetic drug, especially in the case of concomitant psychotic-level pathology with the production of. For example, it may be patients with carcinophobia, and agitated, anxious depression who are first prescribed chemotherapy.

Dimenhydrinate (Dramina, Aviamarin, Ciel)

Rating: 4.7

In this small review of antiemetics, a few comforting words should also be said to those quite healthy people who may experience the unpleasant symptoms of seasickness and airsickness, who get carsick. Anti-emetics are also necessary for patients with various forms of vertigo, vestibular neuronitis, and Meniere’s disease, which are often treated by ENT doctors.

For such patients there are Dramina and its analogues, in which the active ingredient is 50 mg dimenhydrinate in each tablet. This medication belongs to the group of histamine receptor and choline receptor blockers in the central nervous system. Dramine acts on the structures of the vestibular apparatus, its semicircular canals and special pebbles, or otoliths. In addition to reducing nausea and vomiting, this drug significantly reduces appetite, has a sedative effect, slightly reduces the symptoms of allergies, and helps to reduce dizziness.

It is necessary to apply the drug Dramina before a meal. In seasickness adults are recommended to take not more than 6 tablets a day, divided into 3 doses, but for systemic dizziness, Meniere’s disease and labyrinthitis the dosage and the frequency of taking the drug is determined by ENT-doctor. The drug Dramina is produced by the Croatian company Jadran, and a pack of 10 pills costs 180 rubles.

Advantages and disadvantages

Unfortunately, this drug, despite its pronounced antiemetic effect, is characterized by all the disadvantages of the group of histamine receptor blockers. Restlessness, drowsiness, nasal congestion, constipation, dry mouth, urinary retention, and other unpleasant effects often occur. In overdose, all these symptoms are greatly increased, so you should not exceed the required dosage.

On top of that, taking Dramina slows down the driver’s reaction time, so you should not sit behind the wheel after taking this drug, or work with various machines and mechanisms. This drug and its analogues are contraindicated in the first trimester of pregnancy, during breastfeeding, in epilepsy and in glaucoma.

Of course, the list of contraindications and side effects is quite impressive, and some will agree to endure the unpleasant symptoms of seasickness than to take a rather crude drug. But with vestibular neuronitis and attacks of vertigo may be so severe that the patient lies clinging to the bed, it seems to him that the room spins around him in one direction, as on a carousel, and he experiences debilitating attacks of repeated vomiting. It is in such cases that Dramina will alleviate the patient’s condition, with a positive effect far exceeding the side effects listed above.

Validol and peppermint tablets: an antiemetic for all

Rating: 4.7

Finally, at the end of the review we can mention Validol, or mint sublingual tablets. The main component of Validol is levomenthol solution, which irritates, distracts, causes a mild minty chill in the mouth, and reflexively dilates blood vessels. It is believed that reflex Validol really dilates coronary vessels, that is, myocardial vessels, and can help an attack of angina to avoid a heart attack. But in fact, Validol, although it can dilate blood vessels, it does not have to do so at all. But nitroglycerin will do it anyway.

The anti-nausea and antiemetic action lies in the fact that the irritation of the sensitive nerve endings with Validol stimulates the production of endorphins, distracts, cools and changes the perception of the feeling of nausea. As a result, the nausea recedes, and it becomes easier. For example, Validol can be aspirated as an antiemetic in healthy people for air and sea sickness and motion sickness. Take it under the tongue 2 to 3 times a day, or when an attack of nausea occurs, such as when taking off or landing an airplane. Validol is naturally a very cheap drug, and there is no shortage of it in pharmacies. The hypodermic tablets of 10 units will cost from 25 to 35 rubles., And Validol is produced by a mass of domestic pharmaceutical companies and enterprises.

Advantages and disadvantages

For its group Validol has both a mass of advantages and a mass of disadvantages. It is cheap, it can be bought anywhere, it has practically no side effects, except for lacrimation and rare allergic reactions, and it is not given only in case of hypersensitivity to menthol. It is even, however, in extreme cases, can be given to pregnant and lactating women, but it is still better not to do. The main advantage of Validol is that it can reliably cope with nausea, especially in combination with Dramamine in healthy people with a weak vestibular apparatus. But here if we really have to seriously stop the nausea and vomiting that appears when prescribing toxic antitumor drugs to fight malignant neoplasms, then no Validol is not enough here: we need the modern potent agents described above.