Antiemetic drug: definition, list, without prescription

Vogalene, Vogalib, Primperan, Motilium… Antiemetic drugs relieve nausea and vomiting. Can you get them without a prescription? What are the risks and contraindications?

Definition: what is an antiemetic?

It is a drug used in preventive and curative treatment of nausea and vomiting.

What is the mode of action of an antiemetic?

The mechanism of action of an antiemetic is not the same according to the drug class to which it belongs. These drugs target various neurotransmitters: D2 receptors of the dopamine (dopamine antagonists), histamine H1 receptors (antihistamines), 5-HT3 receptors of the serotonin (setrons), the muscarinic acetylcholine receptors (anticholinergics) and substance P NK1 receptors (NK1 antagonists).

What are the indications for an antiemetic?

Not all antiemetics have the same indications. The choice of treatment depends on the intensity and nature of the nausea and vomiting. They are mainly used in the following cases:

  • Treatment of nausea and vomiting without feverincluding those induced by migraine attacks
  • Treatment of nausea and vomiting of pregnancy (Cariban®, Xonvea®)
  • Treatment preventive and curative travel sickness (antihistamines, Scopoderm®)
  • Treatment preventive and curative of nausea and vomiting induced by chemotherapy cancer drug or radiotherapy (setrons, Primperan® and Emend®)

What are the main antiemetics in France?

The main antiemetics currently on the market are the following:

  • Dopamine antagonists: domperidone (Motilium®), metoclopramide (Primpéran®), metoclopramide LP (Prokinyl®), metopimazine (Vogalène®, Vogalib®) and alizapride (Plitican®)
  • Antihistamines: meclozine (Agyrax®), doxylamine combined with a form of vitamin B6 (Cariban®, Xonvea®), dimenhydrinate (Nausicalm® : available for children and adults)dimenhydrinate combined with caffeine (Mercalm®) and diphenhydramine (Nautamine®)
  • Setrons: londansetron (Zophren®) and granisetron (Kytril®)
  • Substance P NK1 receptor antagonist: aprepitant (Emend®)
  • Anticholinergic: scopolamine (Scopoderm® : in the form of patches)

These medicines come in different pharmaceutical forms: film-coated tablet, orodispersible tablet, oral lyophilisate, capsule, drinkable suspension, suppository and solution for injection.

What are non-prescription antiemetics?

Antiemetics available in pharmacies without a prescription are Vogalib® and the antihistamines indicated in motion sickness (Agyrax®, Mercalm®, Nausicalm, Nautamine®).

What are the side effects of antiemetics?

► The most common adverse effects with metoclopramide (Primpéran®, Prokinyl®) and Plitican® are drowsiness, fatigue, depression, diarrhea. A gynecomastia (development of the mammary gland in men) and repetitive movements have been reported. These effects are rarely found with Vogalène® and Motilium® (domperidone). The main side effect of domperidone is dry mouth. It also exposes you to a risk of serious but rare heart attack.
► H1 antihistamines may be responsible for drowsiness, constipation, heart palpitations, urinary retention, dry mouth and blurred vision. Operators of machinery or machines must be vigilant in the face of the possible effects sedatives.
► Setrons frequently cause headaches, hot flushes and constipation. Less frequently, a low blood pressure and heart rhythm disturbances may be observed.
► The main undesirable effects induced by Scopoderm® are sensations of drowsiness and dizziness, visual disturbances, dry mouth and skin irritations.
► The most frequently reported side effects with the drug Emend® are headache, hiccups, constipation, fatigue and increased liver enzymes.

There are no particular contraindications to the use of Kytril®

What are the contraindications of antiemetics?

All antiemetics are contraindicated in case of allergy to any of the components of the drug.
Domperidone should not be prescribed in the following cases: prolactin tumor in the pituitary gland (brain gland), gastrointestinal involvement (haemorrhage, digestive obstruction or perforation), liver failure, heart disease, potassium deficiency or excess .
Metoclopramide (Primpéran® and Prokinyl LP®) or alizapride (Plitican®) should not be taken concomitantly with certain treatments for Parkinson disease and restless leg syndrome. Their intake should be excluded in the event of a tumor in the adrenal glands (located above the kidneys) and in the event of repetitive and persistent movements caused by drugs of the same family. Metoclopramide is also contraindicated in epilepsy, Parkinson’s disease, gastrointestinal disorders (haemorrhage, obstruction, perforation) and excess methemoglobin (a particular form of hemoglobin) in the blood caused by this molecule.
Vogalène® and treatments for motion sickness (Scopoderm®, Agyrax®, Mercalm®, Nausicalm, Nautamine®) should be avoided in patients with a risk of urinary retention (especially in cases of prostate disorders) or a risk of angle-closure glaucoma. Note that Agyrax® is contraindicated in liver failure.
►Lantihistamines with antiemetic properties used specifically in pregnant women (Cariban®, Xonvea®) must not be used in combination with certain medications (ketoconazole, erythromycin) and in the event of porphyria (rare hereditary disease).
► Regarding setrons, Zophren® should not be administered at the same time as apomorphine (antiparkinsonian). The freeze-dried form is contraindicated in case of phenylketonuria (hereditary genetic disease) due to the presence of aspartame. ► On the other hand, there is no no particular contraindication to the use of Kytril®.

The use of essential oils requires the advice of a health professional

What are natural antiemetics?

Natural products can be taken alone or in addition to antiemetic drugs belonging to conventional medicine. Several natural antiemetics are available in herbal medicine, aromatherapy and homeopathy:
Food supplements based on ginger rhizome : Maternov nauseas® (for pregnant women), Pediakid (travel sickness® (for children from 6 months), Phytostandard ginger®, Naturactive ginger®.
Essential oils of ginger, peppermint, lemon, tropical basil. The administration is carried out by cutaneous application (mixture of essential oils diluted in vegetable oil) or by dry inhalation on a handkerchief.
Homeopathic medicines containing associations of several strains (Nux vomica and Cocculus indicus among others): Cocculine®, Famenpax®, Viaborpax®.
The use of plants or essential oils requires the advice of a health professional due to the possible occurrence of adverse effects and the risk of interaction with certain long-term treatments.

Sources:
– Public drug database
– Antiemetic drugs in the symptomatic treatment of nausea and vomiting, Haute Autorité de santé, 27 May 2019
– Antiemetics: the essential points, Pharmacomédicale.org

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