Pharmacology - Anti-emetic Agents
Below is a summary of commonly used anti-emetic agents. Note that some agents are often used for multiple indications. Doses are IV, unless indicated. Also note that less common agents are detailed in the AFMS manual.
The agents are listed with the generic name followed by the trade name in brackets.
Ondansetron (Zofran)
- Mechanism
- 5HT3 antagonist
- Indication
- Anti-emetic
- Dosing
- 0.1 mg/kg or 4 mg
- Considerations
- Provide at end of surgery given short (4h) duration of action
- Caution in patients with prolonged QT
Dexamethasone (Decadron)
- Mechanism
- Reduction of inflammation and opioid use
- Indication
- Anti-emetic
- Dosing
- 1 mg/kg
- Considerations
- Less preferred in diabetic patient as it can cause transient hyperglycemia
Metoclopramide (Maxeran)
- Mechanism
- D2 > 5HT3 antagonism
- Indication
- Anti-emetic
- Dosing
- 10 mg
- Considerations
- May cause anxiety, worsen Parkinsonism
Dimenhydrinate (Gravol)
- Mechanism
- H1 and muscarinic Ach receptor inhibition
- Indication
- Anti-emetic
- Dosing
- 0.5 mg/kg or 12.5-50 mg
- Considerations
- Caution in patients with cardiac disease, BPH, and the elderly given side effects of tachycardia, urinary retention, delirium
Haloperidol (Haldol)
- Mechanism
- D2 antagonism
- Indication
- Anti-emetic
- Dosing
- 0.5-1 mg
- Considerations
- Caution in patients with long QT and Parkinsonism
- May reduce post-op delirium in elderly
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