Overload

Anti-emetics

Category: Medicines

Type

Involuntary

Introduction and description

 

Anti-emetics aim to treat nausea and feelings of sickness, as well as helping with actual vomiting. 

They may be used in cases of motion sickness or following treatment by, for example, chemotherapy. 

Generally if one is sick  - nauseous or vomiting - there is a good reason - one has ingested a toxin and it needs to be expelled, however, occasionally the toxin has been given to us by the medical profession in the first place!

Side effects

There is something very odd happening in the prescribing of this class of drugs.  Given that the class is intended to be used as a one-off treatment for the nausea being suffered by people who need very temporary help, whilst the cause is identified, one would expect any side effects to be only experienced once.  But the ehealthme website shows that for a drug like Ondansetron, for example, there are side-effects that last for years.  The table below is an extract from one that lists symptoms that continue for over ten years.

Most common side effects over time :

< 1 month

1 - 6 months

6 - 12 months

1 - 2 years

2 - 5 years

Vomiting

Diarrhoea

Chloroma

Tooth Extraction

Dysgeusia

Nausea

Nausea

Myelodysplastic Syndrome

Osteonecrosis

Hypersensitivity

Hypotension

Melaena

Fever

Diverticulitis

Vertigo

Cardiac Arrest

Dehydration

Stiffness In A Joint

Jaw Disorder

Visual Acuity Reduced

Dyspnoea

Pyrexia

Hallucinations

Abdominal Pain Lower

Lightheadedness - Fainting

Multi-organ Failure

Pain In Jaw

Petechiae

Pain - Joints

Decreased Appetite

Pyrexia

Abdominal Pain Upper

Blindness

Gingival Disorder

Migraine

Dehydration

Skin Disorder

Hyponatraemia

Thrombocytopenia

Nausea

Pneumonia

Thrombocytopenia

Hyperthermia Malignant

Haemolytic Uraemic Syndrome

Nausea And Vomiting

Febrile Neutropenia

Hepatocellular Damage

 

Mood Disorder Due To A General Medical Condition

Fluid Retention

 

 

Ondansetron , originally marketed under the brand name Zofran, is a serotonin 5-HT3 receptor antagonist used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, surgery and gastroenteritis. 

Not only does this table appear to imply it does not prevent nausea or vomiting, but all sorts of long term effects appear to follow.

If we now take another drug Metoclopramide and look at the most frequently occurring side-effects we find:

Most common side effects by gender  :

Female Male
Tardive Dyskinesia Tardive Dyskinesia
Extrapyramidal Disorder Extrapyramidal Disorder
Nervous System Disorder Nervous System Disorder
Dystonia Dystonia
Pain Pain
Anxiety Anxiety
Movement Disorder Activities Of Daily Living Impaired
Activities Of Daily Living Impaired Movement Disorder
Dyskinesia Dyskinesia
Deformity Nausea

We can see that in males at least it does not prevent nausea, it appears to cause it.

 

Death

One would not expect that a class of drug designed to stop you being sick caused deaths, but it would appear from the information recorded on eHealthme, using Adverse Drug Reports sent by doctors to the FDA and SEDA, that they do, here are the figures:

 

Ondansetron - On Jul, 30, 2015: 2,839 people reported to have side effects when taking Ondansetron. Among them, 38 people (1.34%) have Death

Zofran - On Jul, 21, 2015: 348 people reported to have side effects when taking Zofran. Among them, 3 people (0.86%) have Death

Metoclopramide - On Jul, 20, 2015: 37,374 people reported to have side effects when taking Metoclopramide. Among them, 627 people (1.68%) have Death

Maxolon - On Jul, 15, 2015: 977 people reported to have side effects when taking Maxolon. Among them, 20 people (2.05%) have Death

Reglan - On Jul, 29, 2015: 19,660 people reported to have side effects when taking Reglan. Among them, 383 people (1.95%) have Death

Anzemet - On Aug, 8, 2015: 2,176 people reported to have side effects when taking Anzemet. Among them, 52 people (2.39%) have Death.

Kytril - On Aug, 8, 2015: 7,699 people reported to have side effects when taking Kytril. Among them, 160 people (2.08%) have Death

Aloxi - On Aug, 8, 2015: 2,465 people reported to have side effects when taking Aloxi. Among them, 135 people (5.48%) have Death.

Droperidol - On Aug, 8, 2015: 1,386 people reported to have side effects when taking Droperidol. Among them, 74 people (5.34%) have Death.

Compazine - On Aug, 4, 2015: 5,737 people reported to have side effects when taking Compazine. Among them, 296 people (5.16%) have Death

Emend - On Aug, 6, 2015: 3,247 people reported to have side effects when taking Emend. Among them, 109 people (3.36%) have Death

Diphenhydramine hydrochloride - On Aug, 8, 2015: 2,053 people reported to have side effects when taking Diphenhydramine hydrochloride. Among them, 76 people (3.70%) have Death

Dimenhydrinate - On Jul, 11, 2015: 964 people reported to have side effects when taking Dimenhydrinate. Among them, 22 people (2.28%) have Death.

Doxylamine - On Jul, 19, 2015: 424 people reported to have side effects when taking Doxylamine succinate. Among them, 6 people (1.42%) have Death

Meclizine -  On Jul, 15, 2015: 5,373 people reported to have side effects when taking Meclizine. Among them, 102 people (1.90%) have Death.

Promethazine - On Aug, 1, 2015: 619 people reported to have side effects when taking Promethazine. Among them, 19 people (3.07%) have Death

Vistaril - On Jul, 13, 2015: 4,028 people reported to have side effects when taking Vistaril. Among them, 53 people (1.32%) have Death

How it works

 
 

A number of differently acting drugs are often grouped together within this class making it difficult to work out what is actually going on when anyone gets an hallucination or other experience.

Some drugs based on scopolamine, for example, are classed as anti-emetics, as are some based on serotonin antagonistic action. Thus one has to look at the observations to work out why the hallucinations took place.

References and further reading

 

 

 

The photos on this page are by Evgeny Kolesnik

 

 

 

Observations

The table below summarises the number of hallucinations from the eHealthme web site and uses figures correct as at 2010.  The links take you to the full-side effects for each drug and thus current figures for hallucinations

Medicine

Total number of hallucinations

Metoclopramide

78

Maxolon

46

Reglan

76

Ondansetron

34

Zofran

8

Anzemet

13

Kytril

23

Aloxi

8

Droperidol

13

Compazine

104

Emend

9

Diphenhydramine

77

Dimenhydrinate

4

Doxylamine

11

Meclozine

29

Promethazine

47

Vistaril

118

TOTAL

698

 

 

Tropisetron  -  is a serotonin 5-HT3 receptor antagonist used mainly as an antiemetic to treat nausea and vomiting following chemotherapy, although it has been used experimentally as an analgesic in cases of fibromyalgia. It is marketed in Europe, Australia, New Zealand, Japan, South Korea and the Philippines as Navoban, but is not available in the U.S, hence no figures for hallucinations are available

Domperidone (INN, USAN, BAN, JAN) (trade names Motilium, Motillium, Motinorm Costi, Nomit, Brulium Molax) is a medication that acts as a peripherally-selective antagonist of the dopamine D2 and D3 receptors. It is given in order to relieve nausea and vomiting . As a European drug figures are ot available from eHealthme.

Alizapride (Litican, Plitican, Superan, Vergentan) is a dopamine antagonist used in the treatment of nausea and vomiting, including postoperative nausea and vomiting.  No figures were available.

Cyclizine is an antihistamine drug used to treat nausea, vomiting and dizziness associated with motion sickness, vertigo and post-operatively following administration of general anaesthesia and opioids.  No figures were available from eHealthme, but Wikipedia says "Some people have combined cyclizine with their methadone dose, ... to produce strong psychoactive effects. It has also been used recreationally for its anticholinergic effects to induce hallucinations."

 

 

Related observations