Antiemetics for Nausea and Vomiting

Ondansetron

(5HT-3)

Metoclopramide

(D2, 5HT-3)

Prochlorperazine

(D2, M1, H1)

Promethazine

(D2, M1, H1)

Haloperidol

(D2)

Droperidol

(D2)

Dose

Oral, IM, IV: 4-8 mg

as a single dose

IV: 10-20 mg as a

single dose

PO: 10 mg as a

single dose

PO: 5-10 mg

IM: 5-10 mg;

IV: 2.5-10 mg

PR: 25 mg

Oral, IM, IV,

rectal: 12.5 – 25

mg

IV/IM, PO: 0.5-2

mg

IV/IM: 1.25-2.5 mg

Administration

via IV push

IV: <=10 mg

can be given

IVP over 1-2

min; give

doses >10

mg over at

least 10 min

IV: max rate

Author, year

Design/ sample

size

Intervention & Comparison

Outcome

April, 2018

RCT (n=122)

Inhaled isopropyl alcohol + ondansetron PO

inhaled isopropyl alcohol + placebo PO

inhaled placebo + ondansetron PO

Mean decrease in nausea VAS score was 30 mm

(95% CI 22-37 mm) for group A, 32 mm (95% CI

25-39 mm) for group B, and 9 mm (95% CI 5-14

mm) for group C

No adverse events were reported in either arm

Aromatherapy with or without PO ondansetron

provided greater relief than PO ondansetron

alone

Meek, 2018

RCT (n=215)

Efficacy of droperidol (1.25 mg IV) vs

ondansetron (8 mg IV) vs 0.9% saline

placebo for adult ED nausea

Symptom improvement occurred in 75% (95% CI

64-85%) of droperidol participants, 80% (95% CI

69-89%) for ondansetron, and 76% (95% CI 64-

85%) for placebo

Mean VAS score changes were -29 mm (95% CI –

36 to -23mm) in droperidol, -34 mm (95% CI -41

to -28 mm) in ondansetron, and -24 mm (95% CI –

29 to -19 mm) in placebo

Superiority was not demonstrated for droperidol

or ondansetron vs placebo

Parker, 2018

Retrospective

review (n=35,824)

(Amir Haddad & [email protected]

Antiemetic agents studied in the ED setting include ondansetron, promethazine, prochlorperazine, metoclopramide, and

droperidol.

Clinicians should Optimize therapy based on efficacy, side effect profile, patient’s preference, and cost in selection of

agent.

May utilize IV Benadryl for EPS prevention of agents.

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