Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
J Pain Palliat Care Pharmacother. 2024 Mar;38(1):38-44. doi: 10.1080/15360288.2023.2268065. Epub 2023 Oct 16.
Symptoms of nausea and vomiting are common in palliative care and hospice patients. One of the many classes of medications used for the treatment of nausea and vomiting is dopamine receptor antagonists which are particularly helpful for treating nausea mediated by the chemoreceptor trigger zone (CTZ) and impaired gastrointestinal function. While dopamine antagonists can be very effective treatments for nausea they should be used with caution as they carry the risk of QTc prolongation, have a FDA black box warning for tardive dyskinesia (TD), and increased risk of precipitating psychosis and death in patients with dementia. This review will cover haloperidol, olanzapine, prochlorperazine, and metoclopramide for treatment of nausea and vomiting including evidence of efficacy, pharmacokinetics, and pharmacodynamics to improve safe and effective utilization in clinical practice. This includes medication receptor site affinities at histaminic, muscarinic, serotonergic, and alpha-adrenergic receptors which can help providers anticipate potential adverse effects and risk of extrapyramidal symptoms (EPS), TD, and QTc prolongation. This review also includes considerations for dose adjustments based on renal function, hepatic function, and age. Understanding the pharmacology of dopamine antagonists can help providers choose the best treatment for control of nausea and vomiting and subsequently improve patients' quality of life.
恶心和呕吐是姑息治疗和临终关怀患者的常见症状。用于治疗恶心和呕吐的药物有许多类别，其中之一是多巴胺受体拮抗剂，对于治疗化学感受器触发区（CTZ）介导的恶心和胃肠道功能障碍特别有帮助。虽然多巴胺拮抗剂可以作为非常有效的恶心治疗方法，但应谨慎使用，因为它们存在 QTc 延长的风险，FDA 对迟发性运动障碍（TD）发出黑框警告，并且痴呆患者发生精神病和死亡的风险增加。本综述将涵盖氟哌啶醇、奥氮平、丙氯拉嗪和甲氧氯普胺治疗恶心和呕吐，包括疗效、药代动力学和药效学的证据，以改善临床实践中的安全有效利用。这包括药物在组胺能、毒蕈碱能、5-羟色胺能和α-肾上腺素能受体上的受体亲和力，这可以帮助提供者预测潜在的不良反应和锥体外系症状（EPS）、TD 和 QTc 延长的风险。本综述还包括根据肾功能、肝功能和年龄调整剂量的考虑因素。了解多巴胺拮抗剂的药理学可以帮助提供者选择控制恶心和呕吐的最佳治疗方法，从而提高患者的生活质量。
