Options to treat opioid induced nausea and vomiting

What are your options to treat opioid induced nausea and vomiting?

Nausea is a highly distressing symptom that may occur with or without vomiting and can affect overall outcome. Opioid-induced nausea and vomiting (OINV) may be due to multiple opioid effects, including (a) enhanced vestibular sensitivity (symptoms may include vertigo and worsening with motion), (b) direct effects on the chemoreceptor trigger zone, and (c) delayed gastric emptying (symptoms of early satiety and bloating, worsening postprandially). The treatment may target different receptors: 5-HT3 receptor antagonists (i.e., ondansetron), dopamine receptor antagonists (i.e., promethazine, droperidol), and modulation of opioid signaling (i.e., subcutaneous methylnaltrexone).

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