. 2010 Oct 22;107(42):733–741. doi: 10.3238/arztebl.2010.0733

Table 4. Overview of available antiemetics with well-researched efficacy in preventing PONV.

Active substance	Substance group	Dose for adults	Dose for children	Recommendation grade (literature)	Time of application	Recommendation grade (literature)	Adverse effects and contraindications	Remarks
Dexamethasone	Corticosteroids	4–8 mg	0.1–0.15 mg	A	At induction	B	AEs: increased BG, hypo-/hypertension Rel. CI: diabetes mellitus	Mechanism of action still unclear
Dexamethasone	Corticosteroids	4–8 mg	0.1–0.15 mg	(14, 15, e29 –e31 )	At induction	(e32)		Mechanism of action still unclear
Granisetron	Serotonin antagonists (5-HT3 receptors)	1 mg	0.02 mg/kg	A	End of surgery	B	AEs: headaches, constipation, raised liver enzymes CI: increased QT interval on ECG	Ongoing: pharmacogenetic studies
Granisetron		1 mg	0.02 mg/kg	(14, 15, e33 –e36 )		(e37)
Ondansetron		4 mg	0.1 mg/kg
Palonosetron		0.075 mg	No data
Tropisetron		2 mg	0.1 mg/kg
Droperidol	Dopamine antagonists: butyrophenone (D2 receptors)	0.625–1.25 mg	0.01–0.015 mg/kg	A	End of surgery	A	AEs: psychomimetic, extrapyramidal disturbance, sedation CIs: Parkinson’s disease, increased QT interval	2nd choice for children
Droperidol		0.625–1.25 mg	0.01–0.015 mg/kg	(14, 15, e33, e38)	End of surgery	(e38)
Haloperidol		1–2 mg	No data	A	No effect on efficacy	B
Haloperidol		1–2 mg	No data	(e39, e40)	No effect on efficacy	(e41)
Metoclopramide	Dopamine antagonists: benzamide (D2 receptors)	25–50 mg	0.15 mg/kg	A	30 min prior to end of surgery	D	AEs: extrapyramidal disturbance, hypotension (fast injection)	2nd choice for children
Metoclopramide	Dopamine antagonists: benzamide (D2 receptors)	25–50 mg	0.15 mg/kg	(11, 15)	30 min prior to end of surgery	D		2nd choice for children
Dimenhydrinate	Histamine antagonists (H1 receptors)	62 mg	0.5 mg/kg	A	Intraoperatively	D	AE: sedation
Dimenhydrinate	Histamine antagonists (H1 receptors)	62 mg	0.5 mg/kg	(13, e42)	Intraoperatively	D	AE: sedation
Scopolamine	Anticholinergics (muscarinergic acetylcholine receptors)	1 mg/24 hrs	No data	A	Evening prior to surgery or at induction	A	AEs: dizziness, dry mouth, accommodation disturbances
Scopolamine	Anticholinergics (muscarinergic acetylcholine receptors)	1 mg/24 hrs	No data	(e43)	Evening prior to surgery or at induction	(e43)	AEs: dizziness, dry mouth, accommodation disturbances
Aprepitant	Neurokinin antagonists (NK1 receptors)	40 mg (available only as 80 and 125 mg capsules in Germany)	No data	A	Together with preoperative medication (currently only available orally)		AEs: headaches, constipation	To be considered for patients at high risk of PONV. Only available to be taken orally. Fosaprepitant (can be used IV) = off-label use
Aprepitant	Neurokinin antagonists (NK1 receptors)	40 mg (available only as 80 and 125 mg capsules in Germany)	No data	(e44, e45)			AEs: headaches, constipation

The receptors stated in brackets in the second column are the receptors on which the drug groups indicated in the first line have antiemetic effects. Doses stated are for intravenous administration (except for aprepitant). Side effects listed are the symptoms frequently reported in PONV studies. Level and grade of recommendations according to SIGN criteria; AE: adverse effect; CI: contraindication; BG: blood glucose; ECG: electrocardiogram; IV: intravenous.