Novel approaches to the treatment of nausea and vomiting

Nausea and vomiting are debilitating symptoms complicating many clinical co nditions. Conventional antiemetic agents act as muscarinic, histamine, and dopamine receptor antagonists in the central nervous system, In a retrospec tive analysis, tricyclic antidepressant drugs demonstrated efficacy in long -term treatment of functional nausea. Some cases of vomiting result from im paired gastrointestinal motor activity. Agents which act on gastric seroton in (5-HT4), dopamine, and motilin receptors accelerate gastric emptying and relieve symptoms in gastroparesis, Recent investigations suggest that some patients with refractory gastroparesis may benefit from gastric electrical pacing. The treatment of acute chemotherapy-induced emesis was revolutioni zed by 5-HT3 receptor antagonists; however, these agents are less efficacio us in delayed vomiting. Neurokinin (NK-1) receptor antagonists show promise in treating delayed chemotherapy-evoked emesis. Furthermore, animal studie s indicate a broad spectrum of action for NK-1 antagonists in treating dive rse causes of nausea and vomiting. The cyclic vomiting syndrome is characte rized by discrete episodes of relentless vomiting separated by asymptomatic intervals and is associated with migraine headaches. Antimigraine therapie s including the 5-HT1D receptor agonists sumatriptan reduce the severity of cyclic vomiting attacks. Investigations into these and other novel treatme nts may provide important advances in the care of difficult cases of nausea and vomiting resulting from disparate illnesses.