5 best remedies for vomiting

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

With antiemetics, an amazing situation develops. Without exception, all people are familiar with this unpleasant phenomenon, and there is no such person who has never had nausea and vomiting at least once in his life. However, antiemetics that are sold in pharmacies specifically as “antiemetics” can literally be counted on the fingers. On the other hand, for the treatment of hypertension, bronchial asthma, coronary heart disease, dozens of drugs have been created, although these diseases are far from all.

Why is modern pharmacology so deprived of medicines for nausea and vomiting? Why are there so few of them? The thing is, there are a lot of them. But many of them simply cannot be sold in pharmacies. And now we will find out how vomiting occurs, and what is its physiological meaning.

Physiology of vomiting

Vomiting is a complex and coordinated motor act. It begins with a contraction of the muscles of the upper small intestine, and as a result, a retroperistaltic wave occurs, that is, all the contents of the upper intestine and duodenum are returned to the stomach. After the stomach is full, after about 15 seconds it contracts, and at the same time its lower, pyloric sphincter closes and the upper one opens.

Everyone knows very well from their own experience that it is much more unpleasant and much more painful when there are vomiting movements, and there is nothing to vomit, because the stomach is empty. But when the stomach is full, then the entrance to the stomach opens, there is a strong contraction of the abdominal muscles and the diaphragm, because the stomach itself is not able to cause vomiting with its muscles, and you need to “ask for help”.

After that, synchronization with exhalation occurs, and through the esophagus all the contents are thrown into the oral cavity. Naturally, vomiting cannot occur on inspiration, since it is life-threatening and threatens with pulmonary aspiration, therefore there are strict bilateral neural connections between the vomiting center in the brain and the respiratory center. Only when the breath is over, only when the blood is saturated with oxygen, and the chemoreceptors of the carotid glomus in the carotid artery “give the go-ahead” to exhale, does the respiratory center “give the go-ahead” to the vomiting center. The vomiting center is completely subordinate to the respiratory center (which is more important – vomiting or breathing, especially since they are located next to each other in the medulla oblongata).

Vomiting is usually a defensive reaction, and on many levels. If there is irritation of the pharynx, the root of the tongue, then a gag reflex occurs. If there is severe dizziness, then vomiting may also occur, for example, as a result of motion sickness, motion sickness, or simply excessive riding on a carousel.

Vomiting can also be conditioned by smelling or tasting something extremely disgusting. Vomiting may be medicinal. There are drugs that affect the vomiting center, being dissolved in the blood, such as the alkaloid apomorphine. What nerves conduct signals from receptors to the vomiting center? First of all, these are centripetal fibers of the glossopharyngeal and vagus nerves, which, respectively, make up the ninth and tenth pair of cranial nerves. It would seem that if the fibers of the X pair of cranial nerves are cut, then vomiting will disappear? Yes, it will disappear, but with it, the breath will disappear and the heart will stop beating, so it’s better not to try. The motor fibers descend to the muscles of the anterior abdominal wall and diaphragm. These are the main “vomit” muscles.

Finally, there is also central vomiting, which is not connected either with receptors, or with conditioned reflexes, or with substances dissolved in the blood, but with the direct influence of the people’s center. This is the so-called central vomiting. This is a formidable sign of damage to the brain, its membranes, it occurs with meningitis, with high intracranial pressure. Central vomiting is a “surprise”, it occurs without any warning and without nausea, vomiting in a fountain, which is absolutely unexpected even for the patient himself.

What drugs have an antiemetic effect?

Therefore, all antiemetic drugs can act, respectively, either on the vomiting center of the brain, or on peripheral receptors, or have a mixed effect. Antipsychotics, which are used in psychiatry, perfectly suppress vomiting. This, for example, Aminazin or Triftazin. But for obvious reasons, neuroleptics cannot be freely sold without a prescription, and besides, the antiemetic effect is a side effect. No one would prescribe aminizine or haloperidol to a post-chemo patient with nausea and vomiting.

Coarse, first-generation antihistamines that cause sedation and drowsiness, such as diphenhydramine, diprazine or pipolfen, cope well with vomiting due to the general inhibitory effect on the central nervous system. But this is also not an option: one does not want to introduce the patient into drowsiness and lethargy, as a side effect of the medicine.

You can also affect the receptors, at the very beginning of the afferent, or ascending arc of the gag reflex. But that won’t always help. For example, if using a spray of novocaine or lidocaine to irrigate the back wall of the pharynx and make it insensible, then you can try to make yourself vomit as much as you like by putting two fingers on the root of the tongue. Nothing will work, because the receptors will not be able to transmit information “up”, being “frozen”. Local irrigation with lidocaine perfectly helps with esophagogastroduodenoscopy, with bronchoscopy, to suppress the gag reflex during the introduction of the endoscope tube into the oral cavity. Naturally, irrigation will not help at all if you feel sick and vomit due to poisoning, or motion sickness on a carousel: receptors of a different localization work there: the intestines or the middle ear.

Finally, there are mixed-action drugs that affect both the periphery and the central section: this is metoclopramide, or Cerucal. So he just produces an antiemetic effect as the main one, and, one might say, saved pharmacology. Therefore, there are no other types of antiemetic drugs on sale. In order for the remedy to be freely available, it is necessary that the antiemetic effect be its main action, and not a side effect.

For example, no one will prescribe antipsychotics for sea and air sickness, that is, vomiting of vestibular origin. Of course, you can prescribe antihistamines, but their depressant effect on the central nervous system, sedation and drowsiness, as side effects, will be almost worse than their antiemetic effect.

We are interested in those antiemetics that can be taken on an outpatient basis, solely for symptomatic purposes. No antiemetic is the main one, since they always complement any therapy regimen. Consider when you can prescribe antiemetics, I and when not.

To tear or not to tear?

It is clear that vomiting is a defense mechanism. But the defense may be true, or it may be false. The response to any event may be adequate or inadequate. In the case when the vomiting act is really useful, it should never be oppressed or blocked. The benefit of vomiting always consists in the elimination, removal or removal from the body of those substances that have entered it from the outside, and then vomiting cannot be fought. Moreover, then vomiting is useful and necessary. Accordingly, it is forbidden to use antiemetics for any intestinal infections accompanied by diarrhea, and without diarrhea – when mentioning the fact of possible poisoning, for any intoxication, for example, alcohol. In all these cases, vomiting is an element of its own treatment, and its suppression will lead to a significant deterioration in the condition, making it difficult to remove toxins from the body.

Accordingly, it is possible to prescribe antiemetic drugs only in the case when vomiting will be, in simple terms, “empty character”. When it’s possible? These are the states:

1. vomiting of a central nature, without nausea, when there are symptoms of increased intracranial pressure, such as bursting headaches, congestive optic discs;

2. meningitis is suspected when there is diffuse acute headache, neck stiffness, fever, and vomiting without nausea;

3. an indication for the appointment of antiemetics will be seasickness (sickness), airsickness, that is, vomiting of vestibular origin. Vestibular vomiting occurs with Meniere’s disease;

4. vestibular neuronitis, labyrinthitis, inflammatory pathology of the middle ear;

5. emetics are indicated for intoxications associated with the decay of tumors after chemotherapy and radiation therapy. Therefore, oncological patients are prescribed antiemetics, and although here we are also talking about intoxication, it is not at all associated with toxins that have entered the gastrointestinal tract. They are in the blood, and therefore the oncologist prescribes the main treatment, and antiemetic therapy is used as symptomatic;

6. nausea and vomiting occurs with radiation sickness and acute radiation injury, these are also indications for the appointment of antiemetics;

7. an extensive list of metabolic disorders is also an indication. These are chronic renal failure, elevated levels of acetone in the blood, chronic liver failure, when the liver stops translating the nitrogenous bases accumulated in the blood into soluble urea, and azotemia increases;

8. these drugs are necessarily prescribed for ischemic strokes in the region of the posterior cerebral artery, when the brain stem is affected. These patients experience frequent uncontrollable vomiting;

9. vomiting can be a symptomatic sign of irritation of the vomiting center, for example, with traumatic brain injuries, ranging from concussion to brain contusions (more severe conditions);

10. vomiting as a symptom can occur in patients with malignant tumors of the stomach, while it does not bring any relief. It occurs due to mechanical irritation by a volumetric formation. Therefore, if such a diagnosis is established, then such patients, along with the main treatment of a malignant neoplasm, require the use of antiemetics.

Finally, psychogenic vomiting associated with severe stress or mental illness is quite rare. Here, too, antiemetic drugs can be used, but it is imperative to make sure that there are no natural causes other than those identified.

Rating of the best remedies for vomiting

We proceed to the review of modern antiemetic drugs, which are not so many. First, the INN, or international non-proprietary name, is given. Then – the name of the original drug, if any, then – the listing of generics, trade names or commercial copies. The following is a breakdown of prices for the original drug and for some generics, relevant at the end of April – beginning of May 2020 for pharmacies of all forms of ownership in the Russian Federation.

Itopride (Ganaton, Itomed, Retch)

Rating: 4.9

Ganaton enhances gastric motility by activating the release of acetylcholine and blocks acetylcholinesterase. As a result, acetylcholine lives for a long time, and, in addition, it interacts with dopamine recipes of the central nervous system, which are located in the vomiting center. Therefore, this itopride can also suppress vomiting, which is caused by apomorphine. As a result of inhibition of acetylcholinesterase and the associated antagonism between it and dopamine receptors, it activates gastric motility. As a result, the drug has a good effect on the upper gastrointestinal tract, accelerates the passage of food through the stomach and improves its emptying.

Ganaton is shown to relieve nausea and vomiting, reduce heartburn, it is used in the complex therapy of chronic gastritis, which is not caused by the formation of an ulcer. The use of this drug stops bloating, slows down the feeling of satiety, reduces pain and discomfort in the upper abdomen. Adults need to use Ganaton 1 tablet 50 mg 3 times a day with meals. Ganaton is produced by the well-known pharmaceutical company Abbott, manufactured in Germany and Japan. A pack of 40 tablets will cost from about 660 to 760 rubles. However, there is also a more affordable drug – Retch from Slovakia, its price will be from 290 to 400 rubles.

Advantages and disadvantages

Ganaton is contraindicated in the presence of a stomach ulcer with a high risk of bleeding, with mechanical obstructive processes in the gastrointestinal tract, for example, with intestinal obstruction. It should not be taken by pregnant and lactating women, and children under 16 years of age. There may be side effects. These are constipation, increased salivation, headache, flushing of the skin and increased activity of liver enzymes and bilirubin. However, this drug significantly improves the quality of life and eating comfort in patients with chronic upper GI disease.

Metaclopramide (Cerucal, Perinorm)

Rating: 4.8

Metoclopramide is still the main antiemetic purchased by hospitals, both in tablets and ampoules, and is inexpensive. A package of 50 tablets, produced by Pliva from Croatia, will cost no more than 120 rubles, and the Indian Perinorm will cost only 25 rubles for a package of 100 tablets of 10 mg each.

How does Cerucal work? It affects dopamine receptors, but there is also little cholinergic activity in the periphery. There are two main effects from the use of this drug: an antiemetic effect associated with the inhibition of dopaminergic neurons in the central zone of the vomiting center, and the effect of rapid emptying of the stomach and active passage of food through the small intestine, that is, increased peristalsis. This too may be related to central mechanisms, but also to the activation of cholinergic receptors in the gastrointestinal tract. The drug is indicated primarily for the prevention of nausea and vomiting, for example, in patients with chemotherapy, and in all those conditions that have been described above. In addition, it can be used if vomiting is associated with migraine, but it is better not to use it for vestibular vomiting. Metoclopramide is taken orally before meals, one tablet of 10 mg 3 times a day, the maximum duration of administration is 5 days.

Advantages and disadvantages

The drug has quite a few contraindications. Of course, this is bleeding in the gastrointestinal tract, erosive and ulcerative gastritis, perforation of the stomach and intestines. This is a suspected pheochromocytoma, or adrenaline-producing adrenal tumor, the drug is contraindicated due to the possibility of severe high-pressure attacks. You can not use it for epilepsy and Parkinson’s disease, as well as in the case of extrapyramidal movement disorders, various tics, Tourette’s disease, due to the development of increased convulsive readiness. There may be side effects as well. This is bradycardia, or slowing of the heart rate, in women – amenorrhea. Dry mouth and constipation may occur. On the part of the nervous system in children, involuntary movements in the head and shoulders, headache, and tremors were observed. So Cerucal is a short-term drug, and it cannot be used for weeks and months, it can do more harm than help. So if the patient has chronic dyspepsia, reflux disease, then this remedy is used in extreme cases, and in very short courses.

Ondansetron (Zofran, Latran, Emeset, Emetron)

Rating: 4.7

The next drug, ondansetron or Zofran, is the most serious of all antiemetics. It is used extremely widely in the form of a solution for intravenous and intramuscular administration, lozenges, syrup, and even rectal suppositories. The drug is a selective serotonin receptor antagonist that was not known until 1986. Then these receptors were discovered, and then their selective antagonist was synthesized, which allows them to be blocked.

Why is this needed? Many drugs that are used in oncology are cytostatics, radiation therapy can lead to a sharp increase in serotonin levels. Serotonin activates the fibers of the X pair of cranial nerves, which we talked about above, namely, they contain these receptors, and as a result, a gag reflex is caused, which is not justified in any way. Ondansetron inhibits this reflex by blocking these receptors, both in the central and at the level of the peripheral nervous system.

Zofran is shown as a symptomatic therapy as a means of preventing nausea and vomiting in oncology during chemotherapy or radiation therapy. In addition, in anesthesiology, when the patient “walks away” from anesthesia, nausea and vomiting may occur, and this is a means of preventing postoperative nausea or vomiting. It is especially undesirable if stitches are placed on the stomach, intestines or esophagus.

The drug can be used in a variety of ways, but tablets are described here. In the case of a moderate effect on vomiting of radiation or chemotherapy, 16 mg can be taken 1-2 hours before the start of treatment. If radiation chemotherapy causes severe nausea and vomiting, then it is also necessary to take 1 mg 2-16 hours before the start of therapy, and at the same time administer 20 mg of dexamethasone intravenously.

The English company Glaxo Wellcom produces Zofran, and it is quite expensive. It is the most expensive drug for vomiting today. 10 tablets with a dosage of 8 mg, which is enough for 5 courses of radiation and chemotherapy, will cost an average of 2500 rubles. However, the domestic consumer always has a choice. There is a generic, Latran, which is produced by domestic enterprises Pharmzashchita, a subsidiary of the FMBA of the Russian Federation. A package of 10 tablets of 4 mg will cost, on average, 400 rubles, which means that a dosage of 8 mg will be equivalent to the price of 800 rubles, which is 3 times cheaper than the original drug. But whether this remedy will be as effective is unknown.

Advantages and disadvantages

This drug should not be taken by pregnant and lactating women, as well as children under two years of age, although in pediatric oncology it is used in the form of a syrup. It should be used with caution in patients with arrhythmias and taking beta-blockers. There may be side effects as well. These are urticaria, bronchospasm, dry mouth, chest pain and flushing of the face, a feeling of heat. However, this drug is extremely necessary for such groups of patients associated with chemotherapy and radiotherapy, and is one of the best in its class. It suppresses nausea and vomiting associated directly with the release of serotonin much more than any other remedy.

Domperidone (Motilium, Motiject, Motilac, Motogastric)

Rating: 4.6

Motilium is perhaps the most “promoted” advertising drug. How does domperidone, or Motilium, work? In vain or not in vain it is “stealed” from the screen as a means to improve the functioning of the gastrointestinal tract? This is a real central blocker of dopamine receptors, and it has nothing to do with the gastrointestinal tract, although its action is manifested there. Yes, indeed, it is an antiemetic, and this is due to a combination of dopamine receptor antagonism and peripheral gastrokinetic action, that is, in its effect it is very similar to Cerucal. Domperidone increases the duration of contractions of the antrum of the stomach, duodenum, improves the evacuation function of the stomach and its emptying, and increases the pressure of the lower esophageal sphincter. This is good, because in patients with high acidity and insufficiency of this sphincter, reflux is possible, that is, the reflux of acidic contents from the stomach into the esophagus, with a well-known complex of unpleasant symptoms.

Indications for the drug – relief of symptoms of nausea and vomiting, as stated in the official instructions. How to take the drug? It is recommended to take it half an hour before meals, adults – 1 tablet 3 times a day, but not more than 3 tablets. In pediatric practice, it is better to use a suspension if necessary. Under no circumstances should you take it on your own for more than 7 days without consulting a doctor. Motilium is produced by Janssen Cilag, and 30 lozenges at a dosage of 10 mg each will cost from 630 to 930 rubles. There is a domestic replacement, the Alsi Pharma company from Russia, which is called Motogastrik. Its price in the same dosage and in the same quantity does not exceed 310 rubles.

Advantages and disadvantages

Like any dopaminergic drug, Motilium has contraindications and side effects. Of the side effects that occurred most often are depression, anxiety, headache and lack of sexual desire, drowsiness and diarrhea, breast enlargement, and other unpleasant reactions. Contraindications include a prolactin-producing pituitary tumor, the use of ketoconazole for the treatment of fungal infections, chronic heart failure, bleeding from a stomach ulcer, liver failure, mechanical intestinal obstruction, and other obstructive conditions that can be diagnosed in the gastrointestinal tract.

Dimenhydrinate (Dramina, Aviamarin)

Rating: 4.5

Finally, the last drug that we will describe in the category of antiemetics is Dramina, which is advised to travelers. It is produced by the well-known Croatian company Jadran, and it is inexpensive. A package of 10 tablets of 50 mg will cost from 150 to 170 rubles. Exactly the same tablets are produced by the Russian company Obolenskoye, but their price is not much different: from 115 to 150 rubles. for the same packaging and dosage.

What is this medicine? This, unlike all previous remedies, is a blocker of histamine receptors, and a few m-cholinergic receptors, and its use is just indicated for vestibular vomiting and dizziness. It slightly depresses the semicircular canals and otoliths, therefore it acts as an antiemetic, reduces appetite, has a slight sedative effect, and helps to eliminate dizziness. The medicine begins to act in half an hour and retains its effect during the day.

Therefore, Dramina is indicated for travelers, those who are motion sick, with air sickness and a long journey in a bus, with Meniere’s disease, as well as for the prevention and treatment of vestibular and labyrinth disorders, these are well-known dizziness, nausea and vomiting. The drug should not be used in tumor therapy, ondansetron is better suited for this.

Apply it before meals, adults 1-2 tablets up to 3 times a day. If there is a pathology of the labyrinth, or vestibular disorders not associated with motion sickness, then the dosage remains the same, it is the same for Meniere’s disease. Most importantly, the maximum daily dose for adults should not be more than 7 tablets. If you do not have symptoms of motion sickness, but you are afraid that they may occur, then to prevent the so-called kinetosis, you need to take 1-2 tablets half an hour before the trip, or before the plane takes off.

Advantages and disadvantages

The drug may have contraindications. These are epilepsy, pregnancy and lactation, acute exudative dermatosis, for example, Eczema, or children under 3 years of age. It can be used, but carefully, for glaucoma and prostatic hyperplasia due to the anticholinergic effect, which can provoke urinary retention, this is hyperthyroidism, obstruction of the bladder neck, and so on. There are also side effects, and the most common are stiffness of movements, anxiety, drowsiness, nasal congestion and dry mouth, mild urinary retention. As you can see, you also have to pay for comfort when moving, flying, or on a sea voyage.

Conclusion

As can be seen from the above list of drugs against vomiting, even if the antiemetic effect is the main one, there are still certain side effects, since all these drugs work at the level of the brain. Yes, domperidone also has effects associated with cholinergic receptors of the gastrointestinal tract, but so far it has not been possible to create such an antiemetic that would be devoid of drawbacks. But there is an effective remedy for nausea. These are the well-known “two fingers on the root of the tongue”, which do not have any side effects, and this folk remedy should not be neglected either. When you feel sick, and there is a reason for this, for example, a bust of alcoholic beverages, it is better to use this old method to reduce the symptoms of intoxication.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.