Table 2.

NEUROMODULATORY MEDICATIONS TO TREAT NAUSEA AND VOMITING

Medication(s)	Mechanism(s) of Action	RCTs Demonstrating Efficacy for Nausea and Vomiting	Open Series, Case Reports Suggesting Benefits	Side Effects
Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine)	Norepinephrine reuptake inhibitors with variable serotonin (and dopamine) reuptake inhibition	–	Functional nausea and vomiting Diabetics with nausea and vomiting Functional dyspepsia Cyclic vomiting syndrome	Sleep disturbance Constipation Lightheadedness Palpitations Cardiac arrhythmias
Mirtazapine	CNS 5-HT1A inverse receptor agonist, HT2C, H1 inverse receptor agonist 5-HT2, 5-HT3, α2 receptor antagonist	PONV Functional dyspepsia (trend to reduced nausea)	Hyperemesis gravidarum Vomiting after gastric bypass surgery Gastroparesis CUNV	Sedation Weight gain Constipation
Olanzapine	5-HT2 and H1 inverse receptor agonist, 5-HT2A, 5-HT2C, 5-HT3, 5-HT6, M1, M3, D1, D2, D3, D4, α1 receptor antagonist	CINV Duloxetine-induced nausea and vomiting	Nausea and vomiting in palliative care CUNV	Weight gain Sedation Peripheral edema Tremor Dizziness
Risperidone	5-HT2A, 5-HT2C, H1 inverse receptor agonist, D2, D3, D4, α1, α2 receptor antagonist	–	Opiate-induced nausea and vomiting	Sedation Weight gain Fatigue Movement disorders Tremor Dizziness Dyspepsia
Gabapentin	Acts on α2/δ subunits of voltage-sensitive calcium channels to reduce calcium signalling	PONV CINV (conflicting data)	Hyperemesis gravidarum	Sedation Dizziness Peripheral edema

CINV—chemotherapy-induced nausea and vomiting

PONV—postoperative nausea and vomiting

CUNV—chronic unexplained nausea and vomiting