Customizing Your Antiemetic: What Should You Consider?

  • James MurrettEmail author
  • Jennifer Repanshek
  • Matthew Hinton


Antiemetic choice in the emergency care setting is a complex decision with a wide array of efficacious options. Nausea and vomiting are often undertreated, and there is little evidence that supports the use of one antiemetic over another. When selecting an agent, it is important for providers to be mindful of side effects and possible adverse reactions. Considering a patient’s medical history and medications, pregnancy status, and underlying etiology of vomiting can allow a provider to make an informed choice.


Antiemetic Medication Drug Choice Nausea Vomiting Emesis Side effects Placebo 


  1. 1.
    Meek R, Graudins A, Anthony S. Antiemetic treatment in the emergency department: patient opinions and expectations. Emerg Med Australas. 2018;30:36–41.CrossRefGoogle Scholar
  2. 2.
    Danielsson B, Wikner BN, Källén B. Use of ondansetron during pregnancy and congenital malformations in the infant. Reprod Toxicol. 2014;50:134–7.CrossRefGoogle Scholar
  3. 3.
    Anderka M, Mitchell AA, Louik C, Werler MM, Hernández-Diaz S, Rasmussen SA. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol. 2012;94:22–30.CrossRefGoogle Scholar
  4. 4.
    Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med. 2013;368:814–23.CrossRefGoogle Scholar
  5. 5.
    Fejzo MS, MacGibbon KW, Mullin PM. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States. Reprod Toxicol. 2016;62:87–91.CrossRefGoogle Scholar
  6. 6.
    Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med. 2009;360:2528–35.CrossRefGoogle Scholar
  7. 7.
    Furyk JS, Meek RA, Egerton-Warburton D, Vinson DR. Oligo-evidence for antiemetic efficacy in the emergency department. Am J Emerg Med. 2017;35:921–2.CrossRefGoogle Scholar
  8. 8.
    Mee MJ, Egerton-Warburton D, Meek R. Treatment and assessment of emergency department nausea and vomiting in Australasia: a survey of anti-emetic management. Emerg Med Australas. 2011;23:162–8.CrossRefGoogle Scholar
  9. 9.
    Singer AJ, Garra G, Thode HC. Oligoantiemesis or inadequate prescription of antiemetics in the emergency department: a local and national perspective. J Emerg Med. 2016;50:818–24.CrossRefGoogle Scholar
  10. 10.
    Furyk JS, Meek RA, Egerton-Warburton D. Drugs for the treatment of nausea and vomiting in adults in the emergency department setting. Cochrane Database Syst Rev. 2015;9:CD010106.Google Scholar
  11. 11.
    Braude D, Crandall C. Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: a randomized double-blind, noninferiority trial. Acad Emerg Med. 2008;15:209–15.CrossRefGoogle Scholar
  12. 12.
    Patka J, Wu DT, Abraham P, Sobel RM. Randomized controlled trial of ondansetron vs. prochlorperazine in adults in the emergency department. West J Emerg Med. 2011;12:1–5.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Patanwala AE, Amini R, Hays D, Rosen P. Antiemetic therapy for nausea and vomiting in the emergency department. J Emerg Med. 2010;39:330–6.CrossRefGoogle Scholar
  14. 14.
    Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. Am J Emerg Med. 2006;24:177–82.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • James Murrett
    • 1
    Email author
  • Jennifer Repanshek
    • 1
  • Matthew Hinton
    • 2
  1. 1.Temple University HospitalPhiladelphiaUSA
  2. 2.Department of PharmacyTemple University HospitalPhiladelphiaUSA

Personalised recommendations