Drugs to Control or Stimulate Vomiting (Monogastric) - Pharmacology - Veterinary Manual Drugs to Control or Stimulate Vomiting (Monogastric) (Video) Using a metered dose inhaler and spacer in a cat Drugs to Control or Stimulate Vomiting (Monogastric) By Patricia M. Dowling, DVM, MSc, DACVIM, DACVCP, Veterinary Clinical Pharmacology, Western College of Veterinary Medicine, University of Saskatchewan ; Johann (Hans) F. Coetzee, BVSc, CertCHP, PhD, DACVCP, Iowa State University Systemic Pharmacotherapeutics of the Digestive System Drug Disposition in the Ruminoreticulum Animals possess an arsenal of special abilities for survival, many of which are used for food consumption. Ingesting food can lead to exposure of internal organs to possible food-related disorders, including viral and bacterial infection, toxins, and allergens. Smell and taste are not always effective in determining the quality of food, so nausea, vomiting, and diarrhea are additional mechanisms of defense of the GI system.

Humorally mediated emesis results from emetogenic substances in the systemic circulation that activate the chemoreceptor trigger zone (CRTZ) in the area postrema. The CRTZ lies outside the blood-brain barrier. Neurally mediated emesis results from activation of an afferent neural pathway typically coming from the abdominal viscera and synapsing at one or more nuclei in the emetic center. Most pharmacologic interventions focus on the humoral pathway of emesis, based on neurotransmitter interactions at the CRTZ. The neural pathway has received less emphasis, even though it is a much more important pathway. Nausea is an aversive experience that often accompanies emesis; it is a distinct perception, different from pain or stress. Nausea is more difficult to treat than emesis using antiemetic drugs. This became apparent with the excellent control of drug-induced emesis from cancer chemotherapy, but human patients still experience nausea. This suggests that nausea and vomiting are separate physiologic processes. Motion-induced emesis appears to have a very early evolutionary origin, because it is present in most animal models of emesis.

Motion sickness is thought to result from sensory conflict regarding the body’s position in space, yet there is no satisfactory theory as to why people and animals have this mechanism in the first place. Nausea and vomiting, as defense systems of the GI tract, by necessity must have a low threshold for activation. Cats are well known for their tendency to vomit, particularly when attempting to dislodge hairballs from the throat or upper GI tract. Chronic vomiting in cats may indicate underlying thyroid, liver, or kidney dysfunction and should be investigated. Dogs also vomit often (frequently after eating grass) and often eat their own vomit. Neurotransmitters of Emesis: Acetylcholine (muscarinic receptors) and substance P (NK-1 receptors) act on the emetic center. The CRTZ is stimulated by dopamine (D2 receptors), α2-adrenergic drugs (NE receptors), serotonin (5-HT3 receptors), acetylcholine (M1 receptors), enkephalins, and histamine (H1 and H2 receptors). α-Adrenergic receptors in the CRTZ are important in inducing emesis in cats.

α2-Adrenergic agonists (eg, xylazine) are more potent emetics in cats than in dogs. 5-HT1A antagonists (eg, buspirone) and α2-adrenergic antagonists (eg, acepromazine, yohimbine, mirtazapine) suppress vomiting in cats. CRTZ D2 dopamine receptors are not as important in mediating humoral emesis in cats as they are in dogs. Apomorphine, a D2 dopamine receptor agonist is a more reliable emetic in dogs than cats, and D2 dopamine receptor antagonists (eg, metoclopramide) are not very effective antiemetic drugs in cats. Histamine H1 and H2 receptors are found in the CRTZ of dogs but not cats. Histamine is a potent emetic in dogs but not cats, and H1 antagonists (eg, diphenhydramine) are ineffective for motion sickness in cats. Muscarinic M1 receptors are found in the vestibular apparatus of cats. Mixed M1/M2 antagonists (eg, atropine) inhibit motion sickness in cats.

Substance P binds to NK-1 receptors, which are found in the gut and the emetic center of the CNS. Substance P induces emesis, and selective substance P antagonists (eg, maropitant) are potent antiemetics in both dogs and cats with a broad spectrum of activity against a variety of emetic stimuli. Emetic Drugs: Emetic drugs are usually administered in emergency situations after ingestion of a toxin (see Emetic Drugs ). They generally remove <80% of the stomach contents. The most reliable emetic drugs act centrally to stimulate the vomiting center, either directly or via the CRTZ. Emetic Drugs Dosage Apomorphine Dogs: 4 mg/kg, PO; 0.02 mg/kg, IV; 0.3 mg/kg, SC; 0.25 mg in the conjunctival sac Xylazine Cats: 0.4–0.5 mg/kg, IV or IM Hydrogen peroxide Dogs: 5–10 mL, PO Apomorphine is an opioid drug that acts as a potent central dopamine agonist to directly stimulate the CRTZ. Therefore, it is less effective in cats than in dogs.

It can be administered PO, IV, or SC; the IM route is not as effective. It can also be applied directly to conjunctival and gingival membranes, using the tablet formulation, which can easily be removed once emesis is initiated. Vomiting usually occurs in 5–10 min. Although apomorphine directly stimulates the CRTZ, it has a depressant effect on the emetic center. Therefore, if the first dose does not induce emesis, additional doses are not helpful. Because the vestibular apparatus may also be involved in apomorphine-induced vomiting, sedate and motionless animals will not vomit as readily as active animals. Excitement that results from apomorphine in cats can be treated with the opioid antagonist naloxone. Xylazine is an α2-adrenergic agonist used primarily for its sedative and analgesic action. It is a reliable emetic, particularly in cats, in which it stimulates the CRTZ. Because xylazine can produce profound sedation and hypotension, animals should be closely monitored after administration. Hydrogen peroxide (3%) applied to the back of the pharynx stimulates vomiting via the ninth cranial nerve.

Small doses (5–10 mL) of hydrogen peroxide can be administered via oral syringe until emesis occurs. It should be administered cautiously, especially in cats, because aspiration of hydrogen peroxide foam causes severe aspiration pneumonia. When small amounts are administered, 3% hydrogen peroxide is relatively nontoxic. Stronger concentrations (eg, hair dye peroxide) are more toxic. Other products have been used but are not recommended to induce emesis in dogs and cats. Syrup of ipecac is no longer recommended for "home use" in people or animals. The active ingredient is emetine, a toxic alkaloid, which produces vomiting by acting as a stomach irritant. If repeated use fails to induce emesis, then gastric lavage is necessary to remove the emetine to prevent additional toxicosis. Although sometimes suggested, sodium chloride (salt) and powdered mustard should not be used. Mustard is rarely effective and can be inhaled and cause lung damage, whereas salt toxicity can easily occur if overdosed and can result in fatal cerebral edema. Antiemetic Drugs: Protracted vomiting is physically exhausting and can cause dehydration, acid-base and electrolyte disturbances, and aspiration pneumonia.

Antiemetic drugs are used to control excessive vomiting once an etiologic diagnosis has been made, to prevent motion sickness and psychogenic vomiting, and to control emesis from radiation and chemotherapy (see Antiemetic Drugs ). Antiemetics may act peripherally to reduce afferent input from receptors or to inhibit efferent components of the vomiting reflex response. They may also act centrally to block stimulation of the CRTZ and emetic center.

Antiemetic Drugs 0.025–0.2 mg/kg, IV, IM, SC, maximum 3 mg; 1–3 mg/kg, PO Chlorpromazine 0.5 mg/kg, IV, IM, SC, tid-qid Prochlorperazine 0.1 mg/kg, IM, tid-qid; 1 mg/kg, PO, bid Aminopentamide 0.022 mg/kg, PO, SC, or IM, bid-tid Dimenhydrinate 4–8 mg/kg, PO, tid Diphenhydramine 2–4 mg/kg, PO, tid Butorphanol 0.2–0.4 mg/kg, IM, once to twice daily Metoclopramide 0.1–0.5 mg/kg, IM, SC, or PO, tid; 0.01–0.02 mg/kg/hr, IV infusion Ondansetron 0.1–0.2 mg/kg, PO, once to twice daily; 0.1–0.15 mg/kg, IV, bid-tid Granisetron 0.5–1 mg/kg, PO, bid; 0.1

–0.15 mg/kg, IV, bid-tid Dolasetron 0.6–1 mg/kg/day, IV Maropitant 2 mg/kg, PO or 1 mg/kg/day, SC, for up to 5 days (acute vomiting); 8 mg/kg/day, PO, for up to 2 days (motion sickness) The phenothiazine tranquilizers are α2-adrenergic antagonists and antagonize the CNS stimulatory effects of dopamine and decrease vomiting from a variety of causes, including motion sickness in cats.

These drugs also have antihistaminic and weak anticholinergic action. Phenothiazine tranquilizers used as antiemetics include acepromazine, chlorpromazine, and prochlorperazine. Potential adverse effects include hypotension due to α-adrenergic blockade, excessive sedation, extrapyramidal signs, and a lowering of the seizure threshold in animals with epilepsy. Extrapyramidal signs can be counteracted with an antihistamine (eg, diphenhydramine). The anticholinergic drugs block cholinergic afferent pathways from the GI tract and the vestibular system to the vomiting center. Alone, they are less effective than the other emetics. Aminopentamide is approved for use in dogs and cats in the USA as an injectable formulation and oral tablets. It should be more efficacious in the treatment of motion sickness in cats than in dogs, because muscarinic M1 receptors are found in the vestibular apparatus of cats. Aminopentamide has low efficacy for other causes of vomiting. The antihistamines can block both cholinergic and histaminic nerve transmission responsible for transmission of the vestibular stimulus to the vomiting center of dogs.

The commonly used histamine (H1) blocking drugs are diphenhydramine and dimenhydrinate (diphenhydramine plus 8-chlorotheophylline). They may cause mild sedation, especially diphenhydramine, but paradoxical CNS stimulation may also occur, presumably from anticholinergic effects. Metoclopramide exerts its antiemetic effects via three mechanisms. At low doses, it inhibits dopaminergic transmission in the CNS, whereas at high doses, it inhibits serotonin receptors in the CRTZ. Peripherally, metoclopramide increases gastric and upper duodenal emptying. Metoclopramide is a useful antiemetic for dogs. Because CRTZ D2 dopamine receptors are not very important in mediating humoral emesis in cats, metoclopramide is less effective in cats than in dogs. It is used to control emesis induced by chemotherapy, nausea and vomiting associated with delayed gastric emptying, reflux gastritis, and viral enteritis. There is tremendous individual variability in metoclopramide pharmacokinetics, and oral bioavailability is only ~50% because of a significant first-pass effect.

At high doses or with rapid IV administration, metoclopramide causes CNS excitement by dopamine antagonism (similar to the phenothiazine tranquilizers). Extrapyramidal signs can be counteracted with an antihistamine such as diphenhydramine. Metoclopramide should not be administered if a GI obstruction or perforation is suspected. The serotonin antagonists ondansetron, granisetron, and dolasetron are specific inhibitors of serotonin subtype 3 receptors in the CRTZ. These receptors are located peripherally on vagal nerve terminals and centrally in the area postrema of the brain. Cytotoxic drugs and radiation damage the GI mucosa, causing release of serotonin. These are the most effective antiemetics used in people undergoing radiation and chemotherapy, and they have been used in cats and dogs receiving chemotherapy. Although very effective at controlling vomiting associated with chemotherapy and drug-induced vomiting, these drugs do not prevent or relieve nausea, which may be more debilitating than vomiting. They are not effective for emesis caused by motion sickness. All serotonin subtype 3 antagonists have been associated with prolongation of the QT interval in people.

Adverse effects of dolasetron include ECG changes (PR and QT prolongation, QRS widening) caused by dolasetron metabolites that block sodium channels. Butorphanol is an effective antiemetic for dogs receiving cisplatin chemotherapy. It causes only mild sedation. It is believed to exert its antiemetic effect directly on the vomiting center. Maropitant is a neurokinin 1 (NK-1) receptor antagonist approved to treat and prevent emesis in dogs and cats. Substance P is a regulatory peptide that binds to the NK-1 receptors and induces emesis. NK-1 receptor antagonists are believed to provide antiemetic activity by suppressing activity at the nucleus of the solitary tract, where vagal afferents from the GI tract converge with inputs from the CRTZ and other regions of the brain involved in the control and initiation of emesis. Despite its selectivity for the NK-1 receptor, maropitant blocks apomorphine, cisplatin, and syrup of ipecac–induced vomiting in dogs, which suggests that activation of the nucleus of the solitary tract is a final common step in the initiation of emesis.

Despite being very effective antiemetics in people, NK-1 receptor antagonists have little effect on chemotherapy-associated nausea in people or hydromorphone-induced nausea in dogs. Maropitant injectable is approved for vomiting in cats ≥16 wk old and acute vomiting in dogs ≥8 wk old at 1 mg/kg/day. Maropitant tablets are approved for acute vomiting in dogs ≥8 wk old (2 mg/kg), and to prevent vomiting due to motion sickness in dogs ≥16 wk older (8 mg/kg). Dogs should not be fed for 1 hr before giving maropitant. The best time to give maropitant is 2 hr before travelling, with a small amount of food. The tablets should not be wrapped tightly in fatty food such as cheese or meat, because this may keep the tablets from dissolving and delay the effect of maropitant. Adverse effects are rare with maropitant, but the most common ones are excessive drooling, lethargy, lack of appetite, and diarrhea. Maropitant injections may also cause a stinging sensation; this can be minimized by keeping the injectable solution refrigerated and, once the drug is drawn up, injecting right away at the refrigerated temperature.

A few dogs may vomit after treatment. Giving maropitant with a small amount of food will help avoid this. Resources In This Article Antiemetics Symptoms, Treatment, Causes - What types of medications are available to treat nausea and vomiting? - MedicineNet Medical Author: John P. Cunha, DO, FACOEP John P. Cunha, DO, FACOEP John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey. Medical Editor: William C. Shiel Jr., MD, FACP, FACR William C. Shiel Jr., MD, FACP, FACR Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St.

Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. Share Your Story Drugs used to treat nausea and vomiting are called antiemetics. Many types of antiemetics can decrease the severity of nausea, although most require a medical evaluation and prescription. Medicines available over-the-counter are mainly recommended for use in motion sickness and for cases of mild nausea. Meclizine hydrochloride ( Bonine ) is an antihistamine that is effective in the treatment of nausea, vomiting, and dizziness associated with motion sickness. Unless recommended by a physician, it should not be taken by people with lung diseases, glaucoma , or those who have difficulty urinating due to an enlarged prostate . Meclizine may cause drowsiness and should not be taken with other sedatives such as alcohol, tranquilizers, or sleeping pills. Due to drowsiness, people using meclizine should not drive or operate dangerous machinery. Meclizine is not recommended in children under 12 or in pregnant or nursing women unless recommended by a doctor.

Dimenhydrinate (Dramamine) also is an antihistamine. Its use should be limited to motion sickness. It can cause drowsiness and should be avoided in the same situations as Meclizine. Several different formulations of dimenhydrinate are available, including a children's liquid, which should be used according to the directions under the direction of a physician. Dramamine Less Drowsy Formula contains meclizine, like Bonine, and may have fewer sedative side effects. Both meclizine and dimenhydrinate are recommended to be taken about an hour before travel to prevent motion sickness. Emetrol is an oral solution designed to soothe the stomach when nausea and vomiting are caused by a viral or bacterial infection or overeating. Emetrol contains sugar and phosphoric acid. Diabetics should not use Emetrol without medical supervision because of the concentrated sugar . According to its manufacturer, Emetrol should not be taken for more than five doses in one hour without consulting a physician. Consult a doctor before using this medicine for pregnant or nursing women and young children.

Bismuth subsalicylate ( Pepto-Bismol ) is a product containing bismuth subsalicylate, a chemical shown to be effective in relieving nausea and upset stomach . This remedy has a direct effect on the stomach lining and has no known serious side effects. It may cause darkening of the stool color and of the tongue. Pregnant or nursing women should consult their doctors before using bismuth subsalicylate since part of the active ingredient (salicylate) is chemically similar to aspirin , which may harm infants and the fetus. Patients allergic to aspirin or related drugs also should not use bismuth subsalicylate. Use under the direction of a physician if you take anticoagulants (blood thinners) or have diabetes or gout because the salicylate may further promote the anticoagulant effect. Medically reviewed by Avrom Simon, MD; Board Certified Preventative Medicine with Subspecialty in Occupational Medicine REFERENCE: Emetic | Define Emetic at Dictionary.com emetic causing vomiting, as a medicinal substance. noun an emetic medicine or agent.

Origin of emetic 1650-60; < Latin emeticus < Greek emetikós, equivalent to émet(os) vomiting + -ikos -ic Related forms Examples from the Web for emetic Expand Adventures in Swaziland Owen Rowe O'Neil If taken in small doses it acts as an emetic; if in large doses it kills. Boy Scouts Handbook Boy Scouts of America Indian-Physic or bowman's root, as these names imply, was a popular remedy with the Indians, who used it as an emetic. Ginseng and Other Medicinal Plants A. R. (Arthur Robert) Harding Edwards took the emetic, which had the effect peculiar to that description of beverage. Dr. Jolliffe's Boys Lewis Hough She shows neither impatience nor anger, though she suffered greatly from the emetic they gave her yesterday. British Dictionary definitions for emetic Expand an emetic agent or drug Derived Forms C17: from Late Latin ēmeticus, from Greek emetikos, from emein to vomit Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd.

1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012 Word Origin and History for emetic Expand 1650s (n.), 1660s (adj.), from French émétique (16c.), from Latin emeticus, from Greek emetikos "causing vomiting," from emesis "vomiting," from emein "to vomit," from PIE *weme- "to spit, vomit" (see vomit (v.)).

Online Etymology Dictionary, © 2010 Douglas Harper Antiemetic Medicines: OTC Relief for Nausea and Vomiting - familydoctor.org Antiemetic Medicines: OTC Relief for Nausea and Vomiting Antiemetic Medicines: OTC Relief for Nausea and Vomiting Antiemetic Medicines: OTC Relief for Nausea and Vomiting Antiemetic Medicines: OTC Relief for Nausea and Vomiting What types of OTC medicines treat nausea and vomiting? Over-the-counter (OTC) medicines are medicines you can buy without a prescription from your doctor. Medicines for nausea are called antiemetics. They can help relieve nausea and vomiting. Several OTC medicines are used as antiemetics. Bismuth subsalicylate (some brand names: Kaopectate, Pepto-Bismol) may help treat some types of nausea and vomiting, such as from gastroenteritis (also called “stomach flu”). It’s also used for upset stomach and as an antidiarrheal (medicine to treat diarrhea). Certain antihistamines may help prevent nausea and vomiting caused by motion sickness.

These include dimenhydrinate (brand name: Dramamine) and meclizine hydrochloride (brand name: Dramamine Less Drowsy). How do antiemetic medicines work? Bismuth subsalicylate works by protecting the stomach lining. Antihistamines appear to dull the inner ear’s ability to sense motion. They “block” messages to the part of the brain that controls nausea and vomiting. This is why they work best if you take them before you think you might have a problem with motion sickness. How do I safely take OTC antiemetic medicines? Read the directions on the drug facts label to learn how much medicine to take and how often to take it. If you have any questions about how much medicine to take, call your family doctor or pharmacist. Keep a record (1-page PDF) of the OTC medicines you are using and when you take them. If you need to go to the doctor, take this list with you. Follow these tips to make sure you are taking the right amount of medicine: Take only the amount recommended on the medicine’s label. Don’t assume that more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.

If you are taking a prescription medicine, ask your doctor if it’s okay to also take an OTC antiemetic medicine. Don’t use more than 1 kind of OTC antiemetic medicine at a time unless your doctor says it’s okay. They may have similar active ingredients that add up to be too much medicine. How can I safely store OTC antiemetic medicines? Store all medicines up and away, out of reach and sight of young children. Keeping medicines in a cool, dry place will help prevent them from becoming less effective before their expiration dates. Do not store medicines in bathrooms or bathroom cabinets, which are often hot and humid. What are some common side effects of antiemetic medicines? Healthy adults usually don’t experience side effects from antiemetic medicines. Side effects can be a concern for older adults or people who have health problems. The most common side effects of bismuth subsalicylate are darkened stools or tongue, constipation, and a ringing sound in the ears (tinnitus). These are short-term side effects. Antihistamines may make you feel sleepy. This can affect your ability to drive or operate machines, and it may be hard for you to think clearly.

Alcohol can increase the drowsiness caused by antihistamines. Antihistamines may also cause your mouth and eyes to feel dry. Who shouldn’t take OTC antiemetic medicines? People who are allergic to aspirin or other salicylate medicines should not take bismuth subsalicylate. Don’t give bismuth subsalicylate to children 12 years of age or younger. Don’t give bismuth subsalicylate to children or teenagers 12 to 18 years of age who may have the flu or chickenpox. This increases their risk for Reye syndrome, which is a serious illness that can lead to death. Can OTC antiemetic medicines cause problems with any other medicines I take? Bismuth subsalicylate may affect some medicines so that they don’t work as well. It also may cause side effects if combined with other medicines. Ask your doctor before taking bismuth subsalicylate if you also take: Ask your doctor before taking bismuth subsalicylate if you take pain relievers or cold medicines. These medicines may contain aspirin, which is a salicylate.

You may get too much salicylate if you take more than 1 of these medicines at a time. Talk to your doctor before taking an antihistamine if you take sleeping pills, sedatives, or muscle relaxants. Many OTC cold and allergy medicines contain antihistamines. If you take more than 1 of these medicines, you may take more antihistamine than you intend. Some prescription medicines have side effects similar to the side effects of antihistamines (including dry mouth and drowsiness), so you should also talk with your doctor before taking these medicines at the same time. Blood-thinning medicines Medicines for arthritis Medicines for diabetes Should I talk to my doctor for any other reason before taking an OTC antiemetic medicine? Before taking an antihistamine, talk to your doctor if you have any of the following problems: Glaucoma Trouble urinating (from an enlarged prostate gland) Breathing problems, such as asthma, emphysema, or chronic bronchitis Thyroid disease Ipecac Uses, Benefits & Side Effects - Drugs.com Herbal Database ●...Little exposure or very minor concerns. What is Ipecac?

Also known as Psychotria ipecacuanha, ipecac is a small, perennial tropical plant that is native to the humid forests of Bolivia and Brazil where large plantations have been established to commercialize the collection of ipecac root. Much of the root crop continues to be harvested from the wild, particularly in South America. India also is an important producer of ipecac. At maturity, the roots have a dark brown or red covering, bitter taste, and musty odor. Slideshow What is it used for? Traditional/Ethnobotanical uses Brazilian Indians valued ipecac as a remedy for dysentery, and this information was brought to Europe by Portuguese missionaries. The dried root and rhizome are the source of the medicinally useful products. Ipecac has been widely used in syrup form as a potent and effective emetic. Ipecac powder had been used to induce sweating at the onset of influenza, and small amounts of the extract have been incorporated into cough syrups as expectorants. Emetine, derived from the root, has been used for more than a century to treat dysentery.

Emetic Ipecac induces vomiting by an irritant action on the intestinal mucosa and produces reflex vomiting and diarrhea. It also exerts a central emetic action. Emetine, one of its principle active components, primarily has a central action on the chemoreceptor trigger zone. The syrup induces vomiting in 15 to 60 minutes and is most effective when accompanied by fluid intake. Debate surrounds the use of ipecac. One study found no apparent benefit when syrup of ipecac was used in the home, although there may be a benefit in certain poisonings. This remains to be proven. Ipecac should be administered to an alert, conscious person who has ingested a potentially toxic amount of a poison. Do not administer ipecac to someone who has ingested either a corrosive substance or hydrocarbon with a high aspiration potential (eg, gasoline). Maximum benefit can be expected in those patients who take ipecac soon after poison ingestion. Amebicide Emetine, a component of ipecac, also has amebicidal components. While ipecac is not effective against amebic dysentery, it may be useful for amebic abscesses and hepatitis.

Emetine injected intramuscularly is distributed systemically. What is the recommended dosage? In syrup form, which contains 123 to 157 mg of total alkaloids per 100 mL, ipecac has been used to induce vomiting. The usual dose range for the syrup is 10 to 30 mL, yielding a dose of alkaloids of 12 to 48 mg. Do not confuse the syrup with the fluid extract of ipecac, which is 14 times stronger. Cumulative toxicity requires administration of emetine for amebic dysentery in low doses for a short time with intervals of several weeks before further treatment. How safe is it? Contraindications Do not administer ipecac when a patient has a decreased level of consciousness or has ingested either a corrosive substance of hydrocarbon (eg, gasoline) with a high aspiration potential. Pregnancy/nursing Documented adverse effects include uterine stimulation. Avoid use. Interactions None well documented. Side Effects Repeated exposure to powdered ipecac may cause rhinitis or asthma. Emetine may irritate skin if applied topically.

Diarrhea, lethargy, drowsiness, and prolonged vomiting may occur. Toxicities Ipecac extracts may be highly toxic and should not be confused with syrup of ipecac. Emetine is a cardiotoxin and has been associated with serious cardiotoxicity. References Ipecac. Review of Natural Products. factsandcomparisons4.0 [online]. 2005. Available from Wolters Kluwer, Inc. Accessed April 17, 2007. Copyright © 2009 Wolters Kluwer Health Emetic | definition of emetic by Medical dictionary Emetic | definition of emetic by Medical dictionary 1. causing vomiting . 2. an agent that does this; examples are a strong solution of salt, mustard water, powdered ipecac , and ipecac syrup. Emetics should not be used when lye or other strong alkalis or acids have been swallowed, since vomiting may rupture the already weakened walls of the esophagus. Examples of such acids and alkalis are sodium hydroxide (caustic soda), potassium hydroxide (caustic potash), and carbolic acid.

Emetics should also be avoided when kerosene, gasoline, nail polish remover, or lacquer thinner has been swallowed, since vomiting of these substances may draw them into the lungs. e·met·ic 1. Relating to or causing vomiting. 2. An agent that causes vomiting, for example, ipecac syrup. [G. emetikos, producing vomiting, fr. emeō, to vomit] emetic 1. Relating to or causing vomiting. 2. An agent that causes vomiting, e.g., ipecac syrup. [G. emetikos, producing vomiting, fr. emeō, to vomit] emetic (əmet´ik), n a drug that induces vomiting. emetic 1. causing vomiting. 2. an agent that causes vomiting. A strong solution of salt (1 tablespoon to 1 cup of water), mustard water (1 tablespoon to 1 cup of water), and powdered ipecac or ipecac syrup are examples of emetics. In dogs, commonly in need of such treatment, apomorphine may be used. emetic factor an agent, probably deoxynivalenol, produced by Fusarium graminearum and found in mold-affected grain.

Causes vomiting and food rejection in pigs fed the grain. Called also vomitoxin. ASPCA Tips to Manage a Poison Emergency Front Page : Library : Manage a Poison Emergency ASPCA Tips to Manage a Poison Emergency Jill A. Richardson, DVM, ASPCA Animal Poison Control Center http: ASSESS Assess the condition of the animal. Is the animal seizing? Is the animal breathing? What is the animal's heart rate? What color are the animal's mucous membranes? Is the animal in shock? What is the core body temperature? Is there any evidence of hemorrhaging? What is the basic history of the exposure? What is the toxicant? How long ago was the exposure? How old is the animal? How much does it weigh? Find out this general triage information to be sure that adequate measures can be taken for stabilization and treatment. Once animal is stable, a more thorough medical history should be obtained including complete medical background of the animal, exact toxicant information (including brand name, generic name (especially if it is a medication), and active ingredients.

A more complete history of the exposure should also be obtained including exposure time, amount of toxicant the animal was exposed to, and by what route was the animal exposed (orally, dermally, etc.) Ideally, a support staff member could be taking the history from the owner and phoning the APCC as soon as possible while the animal is being treated. STABILIZATION Stabilization is a priority � TREAT THE PATIENT, NOT THE POISON! Follow the ABC's � Airway, Breathing, and Circulation. Be prepared to intubate the animal upon presentation. Not only will this secure an airway, but also it will help prevent aspiration in the event that gastric lavage is necessary. This may or may not be necessary in every case, but preparation is the key. Have oxygen and an AMBU bag standing by in case they are needed. It is best to try to insert an I.V. catheter upon presentation to allow access for administration of medications and fluids. Once the catheter is placed, draw blood (at least one 3cc EDTA tube and two serum tubes are ideal) for any diagnostic tests to be performed later. If possible these samples should be taken before any other meds are administered.

Monitor the animal for any cardiovascular abnormality. Atropine at a dose of 0.02-0.04 mg/kg I.V. (Plumb, 3rd. ed.) may be recommended for correction of bradycardia. Propranolol is the drug of choice for treating tachycardia, administered slow I.V. at a dose of 0.02-0.06 mg/kg in dogs and 0.04 mg/kg in cats (Plumb, 3rd ed.). These drugs as well as detailed protocols for their administration (in case a veterinarian is not readily available) should be easily accessible in a crash cart. Control seizures. If an animal is seizing when it presents, controlling the seizures is a top priority. Drugs to have on hand for this purpose are diazepam, barbiturates, methocarbamol (Robaxin�), or inhalant anesthetics such as isoflurane, or halothane. It may be necessary to mask an animal down to get the seizures under control. Specific doses of these drugs are going to very depending on the agent involved.

PREVENTION OF TOXICANT ABSORPTION Perform the appropriate method(s)of decontamination. What that method is depends greatly on the agent involved and the condition of the animal at presentation. We will go into great detail about this later in the presentation. CONTROL SIGNS Administer the specific �antidote�, if applicable. Antivenins or antitoxins should be administered at this point. Keep in mind that in more cases than not, there is NO specific antidote. Remember, TREAT THE ANIMAL NOT THE POISON. Preventive measures such as gastric protection or antibiotics may be needed. Administer the proper fluids to correct acid base balance, hydration, and electrolyte imbalances. The two most commonly used fluids are Lactated Ringers Solution and normal saline due to their versatility and availability. Intravenous is the preferred route of administration of fluids, due to the speed of delivery. ANCILLARY SUPPORT Once the animal is stable, it is time to evaluate the damage. Ancillary procedures should be performed to prevent damage from the toxicant. The systems that are most likely affected by the toxicant should be monitored. Complete serum chemistry panels, coagulation panels, or diagnostic tests may be needed.

Appropriate supportive care should be given until the animal completely recovers. PREVENTING ABSORPTION OF THE TOXICANT External Exposures Ocular Irrigation With any ocular exposure, the eyes should be flush repeatedly with water or saline solutions for a minimum of 20-30 minutes. Only normal saline or tepid distilled water should be used � not contact solutions as they can have cleaning agents in them. A large syringe (60 cc) is ideal for flushing eyes. Always remember to flush eyes from the inner corner out so contamination of the opposing eye does not occur. After flushing, the eyes should be treated with lubricant ointments (not medicated) and examined for corneal damage. The eyes should be monitored for excessive redness, lacrimation, or pain. Follow up examinations may be needed to establish level of corneal damage. Bathing The animal should be bathed in a mild hand dishwashing detergent (NOT AUTOMATIC DISHWASHING DETERGENTS). Baths may need to be repeated to completely remove the toxicant. Afterwards the animal should be rinsed well with warm water. Great care should be taken in bathing very young or debilitated animals to maintain normal body temperature.

The animal should be towel dried, not blow-dried, to prevent chilling. Oral Ingestion Dilution Dilution with milk or water in combination with demulcents is recommended in cases of corrosive ingestion. A demulcent is an agent that coats or soothes the stomach. Examples of demulcents would be Kaeopectate�, Mylanta�, or milk of magnesia. A dosage of 1-3mg/lb is a suggested dose. Emesis Emesis (vomiting) is most productive if performed within 2-3 hours post ingestion. Feeding the animal a small moist meal before inducing vomiting can increase chances of an adequate emesis. Emetics generally empty 40-60% of the stomach contents and are assumed to be more beneficial than gastric lavages. Dogs, cats, ferrets, and potbelly pigs are examples of house pets that can vomit. Emetics should not be used in rodents, rabbits, birds, horses, and ruminants. Emesis is contraindicated with ingestion of alkalis, acids, corrosive agents, or hydrocarbons due to the risk of chemical burns or aspiration.

The pre-existing condition of the animal also determines the indication for using an emetic. Emesis should not be induced at home in an animal that has a history of epilepsy, cardiovascular disease, or is debilitated. Veterinary supervision is recommended in these situations. Recent histories of abdominal surgery or potential for a gastric torsion are other factors that could make emesis a contraindication. It may be safest, depending on the situation, to induce vomiting in brachycephalic (short-nosed) breeds at the veterinary hospital versus at home due to aspiration risk. Emesis should not be attempted if the animal has already vomited or is exhibiting clinical signs. Some drugs can have anti-emetic effects. Examples of such drugs include phenothiazines, antihistamines, barbiturates, narcotics, antidepressants, and marijuana. It is important when taking the history to find out if the animal has been taking these or any other medications. Emetic Agents Three-percent hydrogen peroxide is an effective emetic for the dog, pig, ferret, and cat. Do not induce emesis in rodents, rabbits, birds, horses, or ruminants. The dosage is 1 teaspoon per 5 lbs., not to exceed 3 tablespoons.

It should be administered undiluted � not mixed into water or food. However it is helpful to feed a small, moist meal of either canned food or a slice of bread before inducing vomiting, as it makes emesis more productive by giving the toxicant something to adhere to. Bulb syringes, feeding syringes, or turkey basters aid in administration. Hydrogen peroxide causes vomiting through mild gastric irritation. Vomiting usually occurs within minutes and can be repeated once if not initially successful at causing emesis. Syrup of ipecac acts by causing gastric irritation and also stimulates the central nervous system to induce vomiting. In dogs, 2.2 ml/kg (not to exceed 30 ml) is administered by mouth. 3.3ml/kg should be diluted 1:1 and administered to cats via nasogastric tube. Syrup of ipecac should not be administered to cats at home. The syrup should only be used once because repeated dosages have the potential to be cardiotoxic. Never use ipecac fluid-extract because it is about 14 times more cardiotoxic than the syrup. Ipecac fluid-extract is no longer commercially available in the United States.

Apomorphine Hydrochloride should be used cautiously in cats. It is considered to be the emetic of choice in dogs by many clinicians. Apomorphine can be administered parentally or topically to the eye. The recommended dose is 0.04mg/kg IV or conjunctivally. When given intravenously in dogs, emesis occurs very rapidly. Topical administration to the conjunctival sac is usually effective. Apomorphine is a centrally acting emetic, meaning it stimulates receptors of the central nervous system to cause vomiting. Side effects such as CNS and respiratory depression, ataxia, excitement, and protracted vomiting can be seen with apomorphine but are more common after IV usage. When severe side effects are seen, apomorphine can be reversed with Naloxone (0.04mg/kg IV, SQ, and IM.) Xylazine is an alpha 2-adrenergic agonist, which can cause emesis in dogs and cats. Xylazine can cause bradycardia, hypotension, reduced respiratory rate, and CNS depression. The side effects of Xylazine usually outweigh the benefits for its use as an emetic.

The dosage for cats is 0.44 mg/kg IM while the dosage for dogs is 1.1mg/kg SQ or IM. Xylazine can be reversed with Yohimbine at a dose of 0.1 mg/kg IV. Activated Charcoal Activated charcoal adsorbs a chemical or toxicant and facilitates its excretion via the feces. It basically acts like a magnet, attracting and holding the toxicant to its surface so that it passes through the gastrointestinal tract without being absorbed by the body. It is administered when an animal ingests organic poisons, chemicals or bacterial toxins or if enterohepatic recirculation of metabolized toxicants can occur. Enterohepatic recirculation occurs with some compounds that are metabolized in the liver. The metabolites are emptied in the bile and are reabsorbed in the intestines, which would allow for a persistent pharmacological effect. The recommended dose of activated charcoal for all species of animals is 1-3 gm/kg body weight. Repeated doses of activated charcoal every 4-8 hours at half the original dose may be indicated when enterohepatic recirculation occurs.

Activated charcoal can be given orally with a large syringe or with a stomach tube. In symptomatic or uncooperative animals, anesthesia may be needed. A cuffed endotracheal tube should be used in the sedated or clinically depressed animal to prevent aspiration. Activated charcoal should not be given to animals that have ingested caustic materials. These materials are not absorbed systemically, and the charcoal may make it more difficult to see oral and esophageal burns. Other chemicals that are not effectively absorbed by activated charcoal include ethanol, methanol, fertilizer, fluoride, petroleum distillates, most heavy metals, iodides, nitrate, nitrites, sodium chloride, and chlorate. Cathartics Cathartics enhance elimination of the activated charcoal. Without cathartics, the toxicant bound by charcoal can eventually be released and reabsorbed. Cathartics are not to be used if the animal has diarrhea or is dehydrated. Saline cathartics such as sodium sulfate (Glauber's salt) or magnesium sulfate (Epsom salt) should be added at a dose of 250 mg/kg. Magnesium can cause depression and muscle weakness and should not be used in animals with compromised renal function.

Sorbitol is an osmotic cathartic that can be used safely at a dose of 3 ml/kg with repeated charcoal administration. Some premixed solutions of activated charcoal will have sorbitol added. It has a sweet taste that sometimes entices the animal to drink it. Bulk cathartics are indicated in the case when bulky products or physical agents are ingested and its elimination needs to be aided. Psyllium can be given at �-1 teaspoon every 12-24 hours. Bran fiber or vegetable fiber (pumpkin, sweet potato) could also be used. Enemas Enemas are helpful when elimination of toxicants from the lower gastrointestinal tract is desired. Activated charcoal can be used in enema solution to help adsorb toxicant. Premixed enema solutions for humans are contraindicated in small animals due to potential electrolyte/acid-base imbalance. General technique is to use plain warm water or soapy warm water. Gastric Lavage Gastric lavage should not be performed in cases of caustic or petroleum distillate ingestion. General anesthesia should be performed when performing a lavage. The type of toxicant involved in the exposure should always be considered when choosing an anesthetic agent.

Isoflurane is the optimal anesthetic agent, but diazepam or a short-acting barbiturate may be appropriate. Enterogastric Lavage May be necessary when potentially lethal oral exposures have occurred. Examples of agents when enterogastric lavage may be indicated would be strychnine, metaldehyde, tricyclic antidepressants, 5-fluorouracil, and isoniazid. Gastric lavage should be performed before attempting the enterogastric lavage. The stomach tube is left in place after the gastric lavage. An enema is performed to eliminate large pieces of fecal matter from the colon and upper large intestines. With the enema tube still in place, digital pressure is applied at the rectal orifice to form a seal. Then attach the distal end of the tube to a water faucet. Body temperature water should be slowly allowed to fill the intestinal tract until it flows from the stomach tube. The process should continue until the fluid is clear. THIS SHOULD ONLY BE PERFORMED UNDER THE DIRECT SUPERVISION OF A VETERINARIAN.

A pre-anesthetic dose of atropine (0.02 mg/kg) should be given, unless contraindicated, to relax the smooth muscle in the gastrointestinal tract and to prevent abdominal distention. Complications of the procedure include intestinal rupture and possible gastroenteritis. Decontamination Do's and Don'ts Bathe a seizuring animal. (Always stabilize the animal first.) Use salt as an emetic agent. Induce emesis in a seizuring, extremely stimulated, or hyperactive animal. Induce emesis in a vomiting animal. Induce emesis in a severely lethargic, comatose, or debilitated patient. Induce emesis in an animal that has had recent abdominal surgery. Induce emesis in an animal that has a megaesophagus. Induce emesis with a corrosive ingestion. Induce emesis with hydrocarbon/ petroleum distillate ingestion. (In most cases) Induce vomiting on a bird, rabbit, rat, horse or ruminant. Use apomorphine as an emetic agent in the cat. (This is controversial.) Administer xylazine or apomorphine as an emetic in a depressed animal.

Administer activated charcoal for most heavy metals, corrosives, or petroleum distillates. Administer activated charcoal to a vomiting animal. Administer activated charcoal to an animal in ileus or a gastric obstruction. Administer a cathartic to a dehydrated animal or one with diarrhea. Use a magnesium sulfate cathartic in a renal compromised animal. Use pre-mixed enema solutions such as hypertonic phosphate solutions. Perform a gastric lavage without using a cuffed endotracheal tube. DRUGS COMMONLY USED IN TOXICOLOGY Drugs used for decontamination What are Emetics? (with pictures) What are Emetics? Last Modified Date: 28 December 2016 Copyright Protected: These 10 animal facts will amaze you Emetics are chemical compounds which can be administered to induce vomiting . One well known and widely used emetic is syrup of ipecac , but there are other compounds available, and some emetics can be made from common household items. These compounds are used in a wide variety of settings around the world. It is important to administer these with care, as overuse can endanger someone's health. Before using such drugs, people should call a doctor or nurse for advice.

One of the classic reasons to use an emetic is because someone has ingested something which could be harmful. The emetic is used to get the patient to bring up whatever he or she consumed before it has a chance to be absorbed by the body. They can be used in cases of drug overdoses, poisoning, accidental exposure to allergens, and so forth. It is important to make sure that the emetic is administered in a hospital, as there may be cases in which emetics are actually contraindicated. If someone is exposed to something dangerous, a poison control center should be called for advice. Some emetics are designed to be swallowed, while others can be injected. Vomiting can happen almost immediately after the drug is introduced to the patient's system, and can persist for varying lengths of time. If emetics are used, the patient must be kept properly hydrated, as excessive vomiting can lead to dehydration. The patient may also experience other symptoms, such as sore abdominal muscles from stomach cramps . If emetics are administered in excess, the patient's heart can become strained. Historically, people were advised to keep emetics in their home for use in case of emergency.

This practice is less encouraged today, in part because they are not always recommended for use, and also because there is a potential for children or pets to become ill if they consume an emetic in large volume. In addition, such compounds are sometimes used by people with eating disorders to purge, and making them less accessible by keeping them out of the house can be beneficial. Sometimes, people want to stop vomiting, instead of starting. Drugs known as antiemetics can be used in this case. These can also be combined with anti-nausea drugs. People often feel nauseous and experiences frequent emesis during cancer treatment and treatment for some other diseases. People who experience excessive vomiting should discuss it with their doctors to see if there are treatment options available. Ad 5 Ways to Induce Vomiting - wikiHow Inducing Vomiting with the Gag Reflex 1 Open the victim's mouth. Make sure the head is pointed downward to prevent choking. Make sure they are not laying on their back, which could cause them to choke. Put them in the recovery position. It is possible to use the gag reflex to induce vomiting in either yourself as well, using this same method.

Using this as a self-method, however, can take some willpower to gag enough to vomit. 2 Insert your index and middle fingers into the person's mouth. Place your fingers on the tongue and move along the tongue with your fingertips toward the back of the person's throat. 3 Press downward with your fingertips when you touch the back of the person's throat. If that doesn't induce vomiting, then tickle the back of the person's throat with your fingertips. 4 Be prepared for the vomit. If the person starts to convulse and vomit, do your best to get out of the way and direct them towards a toilet, container, or other convenient spot. However if they swallowed something poisonous and you need to act quickly, don't delay for the sake of the carpet. 5 Wash your hands. If the person vomits on your skin, you need to make sure to wash your hands thoroughly with warm water and soap. Method Unverified Home Remedy: Preparing a Mustard Solution 1 Mix mustard and warm water. One tablespoon of mustard spread into one cup of warm water will create an emetic, or a substance that induces vomiting. There is little scientific evidence to suggest that this solution is effective and safe.

It is considered an unverified home remedy and should be treated as such. 2 Drink the mustard solution quickly. If the warm mustard water sounds unappetizing, it's because it's supposed to make you vomit. Try pinching your nose or holding your breath while you drink the solution if it's too hard to get it down. 3 Wait for 20-30 minutes for vomiting to take effect. If that time passes without vomiting, the solution was likely ineffective. Method Unverified Home Remedy: Preparing a Saline Solution 1 Mix salt and warm water. 3 teaspoons of salt into 16 ounces of warm water will create a good emetic. Be careful when drinking salt water as an emetic. Too much of it can potentially be deadly. [1] [2] 2 Watching Someone Else Vomit 1 Ask someone to vomit. Watching someone else vomit can induce vomiting. Scientists call this sympathy vomiting. [3] Sympathy vomiting can occur even if the indirect vomiting party doesn't have an illness like the direct party. The safest and most effective way to do this is to activate the gag reflex, as detailed. 2 Wait for the person to vomit.

When the person does vomit, watch closely and try to inhale the smell of their vomit. If it triggers a wave of nausea, don't try to fight it, but use that nausea to cause yourself to vomit. Only use this method after other safe methods have failed and you've called the relevant professionals. Community Q&A If this question (or a similar one) is answered twice in this section, please click here to let us know. Tips If you know what poison the victim swallowed, keep the bottle, and give it to the paramedics. Any information that you can give paramedics will ensure that your victim gets the best possible treatment. Monitor the condition of the victim after the vomiting, as vomiting may not remove all the harmful substances from the body. Even if you have successfully gotten the person to vomit, the person still needs medical attention. Drink a large amount of water (750mL) before using your fingers. Don't self induce vomiting for the purpose of weight lose or "purging". Doing so can be dangerous and result in death. Sympathy vomiting can also work by watching a video of someone puking.

Put your index finger deep inside your mouth and tap the uvula, or the part of the mouth that dangles downward. After, pull it out quickly. Drinking milk can help. If you are lactose intolerant, this may cause you to go to the restroom and may exclude the waste your were going to vomit. Try mixing sauces and water, then drink some of it. The weird texture and the taste will get to you. Worst case, eat a large pepper if available.(Ghost pepper works),then eat some foods if you haven't already. The spiciness will literally make you vomit and or having the runs will exile the toxin. Try eating a really bitter pill, it may taste bad enough to induce vomiting. Warnings Never ever make someone vomit that isn't conscious anymore. This'll cause them to choke right away. If you are inducing vomiting regularly as a way to lower your weight, or if you binge on food and then "purge" (vomit) to get the food out of your system, then you may be suffering from an eating disorder known as bulimia nervosa . Long-term vomiting can cause dehydration, damage to your tooth enamel or permanent damage to your esophagus.

If you think you have an eating disorder like bulimia, you need to talk to someone, either a counselor or a doctor, right away. This should only be done in an emergency if a doctor instructs you to do so. Inducing vomiting can be harmful, especially in certain health circumstances. Never induce vomiting if: Your victim has swallowed a cleaning product or something that is acidic or alkaline. The chemicals could severely burn the throat and mouth if you make the person vomit. The victim swallowed a petroleum-based product. If the person vomits, then the fumes that come up could be inhaled and could cause pneumonia. The person is confused or seems groggy The person is a child who is too young to follow directions You are in doubt. If you do not know what to do, either call Poison Control or call for emergency medical help. Ipecac syrup was for decades commonly used as an emetic to induce vomiting in poison control situations. It is a poison that reliably induces uncontrollable vomiting in those that take it. However in recent years it has been shown to be ineffective and even harmful in poison control situations, reducing the effectiveness of antitoxins and other treatments. [4] Its production and recommended use has been discontinued.

It can also cause serious allergic reactions in some people. [5] If you have ipecac syrup, don't use it unless poison control directs you to as a last resort. Also never use ipecac syrup on patients who are pregnant, have heart disease, or have digestive tract problems like ulcers, Crohn's disease or infections. [6] Nausea and vomiting - Information and support - Macmillan Cancer Support morphine-based medicines , which are used as painkillers. Physical causes of nausea and vomiting Sometimes, nausea and vomiting can be caused by the following reasons: Changes in the body chemistry – High levels of calcium in the blood can cause nausea and vomiting. Pressure in the brain – If the pressure in the brain is raised, it can affect the vomiting centre and cause you to be sick. Damage to the liver – If the liver isn't working properly, waste products can build up in the blood, leading to nausea and vomiting. Constipation – This can sometimes cause nausea and vomiting. Bowel obstruction – Some cancers, especially cancers that affect the pelvis or abdomen, can cause the bowel to become blocked (bowel obstruction), making you vomit.

Emotional causes of nausea and vomiting In other cases, there are emotional reasons for nausea and vomiting. Examples of these include the following: Anxiety – Feeling anxious about the cancer or your treatment may cause nausea and vomiting. Feelings of nausea and vomiting before treatment (anticipatory nausea) – Sometimes, feelings of nausea and vomiting can be triggered by a situation that reminds you of when you were feeling or being sick in the past. This is called anticipatory nausea. It can occur with chemotherapy and other cancer treatments. The drugs are given by injection into a muscle (intramuscular injection). Under the skin (subcutaneously) You may have the drugs as an injection into the fatty tissue under the skin, using a small needle and syringe. They can also be given over several hours through a pump attached to a small needle that is placed just under the skin. Suppositories These are put into the back passage (rectum), where they dissolve and are absorbed into the bloodstream through the lining of the gut. Skin patches Some anti-sickness drugs can be absorbed through the skin (transdermally) from a small patch that is stuck on to the skin like a plaster. The patch is usually changed every couple of days.

ondansetron (Zofran®) tropisetron (Navoban®). Palonosetron (Aloxi®) is a new 5HT3 blocker that works over a longer time and is given as a weekly injection. Steroids These are often given with other anti-sickness drugs to treat nausea caused by chemotherapy . They can also be used to help with sickness when someone has advanced cancer . Dexamethasone is the most commonly used steroid. Metoclopramide (Maxolon®) and domperidone (Motilium®) These commonly used drugs work by helping to empty the stomach to relieve feelings of sickness. Prochlorperazine (Stemetil®) and chlorporamazine These drugs work by acting on the vomiting centre in the brain to help control sickness. Prochlorperazine (Stemetil®) can be given as a tablet that dissolves in the mouth (Buccastem®). Chlorporamazine is occasionally used in advanced cancer, when other anti-sickness drugs haven't worked. Anti-histamine drugs Cyclizine (Valoid®) is an anti-histamine drug that is often used to treat sickness.

Sedative drugs Haloperidol (Serenace®) is a sedative that can be used in low doses to treat sickness caused by drugs like morphine. Levomepromazine (Nozinan®) is another sedative drug that may be used in advanced cancer, when other anti-sickness drugs haven't worked. These drugs can be taken as tablets or given through a small pump called a syringe driver. This is used when someone is having difficulty swallowing. Anti-anxiety drug Lorazepam (Ativan®) is an anti-anxiety drug that is usually used, along with another anti-sickness drug, to help control nausea caused by chemotherapy. Neurokin 1 (NK1) inhibitor NK1 inhibitors are drugs that work by blocking a chemical that affects neurokinin receptors in the body that cause nausea. They are usually given along with steroids and a 5HT3 inhibitor to control sickness caused by chemotherapy, particularly with a drug called cisplatin . Examples of NK1 inhibitors include: aprepitant (Emend®), which is given as a tablet fosaprepitant (Ivemend®), which is given as an injection into a vein. Let your doctor know if this is a problem.

Indigestion Indigestion can be caused by dexamethasone. It may help to take these tablets with or after food. Tell your doctor if indigestion is a problem for you, as they can prescribe medicines to help. Difficulty sleeping (insomnia) Dexamethasone may make it difficult for you to get to sleep . This problem can be reduced by taking your last dose of the day early in the afternoon, rather than in the evening before you go to bed. Twitching Metoclopramide may cause muscle twitching. This can affect different parts of the body, including the face, neck and shoulders. This is more commonly seen in children and young adults. If you notice this side effect, stop taking the tablets and tell your doctor, as other medicines may be better for you. Eating problems caused by sickness If feeling sick is putting you off your food, the following tips may help: Avoid eating or preparing food when you feel sick. Avoid fried foods, or foods with a strong smell. Preparing small meals and eating little and often can be helpful. Eat cold or warm food if the smell of hot food makes you feel sick. Eat little and often and chew your food well.

Peppermints or peppermint tea may help some people. Sip drinks slowly. Ginger biscuits or ginger beer can help some people. Try not to drink a lot just before you eat. Relaxation Using relaxation tapes or taking part in activities that you find relaxing may help you cope with nausea. Acupuncture There is some evidence that acupuncture may help to control nausea, but more research is needed. Acupuncture involves placing thin, sterile needles into the skin to affect energy points. It is part of traditional Chinese medicine. Sea-bands® (acubands) use the principle of acupressure , which is similar to acupuncture. They apply pressure to specific points on the body, usually the wrist, to control nausea. Some people find acubands helpful in reducing nausea. They are available from chemists and health food shops.

Question: What do 'Emetic' drugs induce?
Answer: VOMITING