5-HT3 receptor antagonists - these block serotonin receptors in the central nervous system and gastrointestinal tract. As such, they can be used to treat post-operative and cytotoxic drug nausea & vomiting.
Cannabinoids are used in patients with cachexia, cytotoxic nausea & vomiting or are unresponsive to other agents.
Cannabis (Marijuana). Most patients prefer smoked or vaporized cannabis over pharmaceutical versions because they do not contain all 66 cannabinoids that are in cannabis, many of which have medicinal applications. CBD is a main cannabinoid not in Marinol or Cesamet.
Dronabinol (Marinol). Ninety percent of sales are for cancer and AIDS patients. The other 10% of its sales thought to be for pain, Multiple Sclerosis and also for Alzheimer's disease.
Nabilone (Cesamet). Put back on the market in late 2006. In the US, it is A Schedule II substance unlike Marinol which is Schedule III and cannabis which is Schedule I.
Sativex is an oral spray containing THC and CBD. It is currently legal in Canada and a few countries in Europe but not in the U.S.
Midazolam given at the onset of anaesthesia has been shown in recent trials to be as effective as ondansetron, a 5HT3 antagonist in the prevention of post-operative nausea and vomiting. Further studies need to be undertaken.
Lorazepam said to be very good as an adjunct treatment for nausea along with first line medications such as Compazine or Zofran.
Non-pharmaceutical therapies with some evidence of efficacy include acupuncture and hypnosis. All drugs have potential side effects. It is important to try to reduce the baseline risk of nausea and vomiting, particularly with respect to surgery.