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Because of the efficacy of dopamine antagonists in treating migraine headaches, dopamine is thought to be a primary mediator.
A small RCT15 involving 29 patients found that intramuscular droperidol and meperidine (Demerol) provided equal pain relief.
Costs for these agents in the treatment of patients with postoperative nausea range from approximately to 5 per dose.7Antiemetics frequently are used to treat nausea induced by vestibular or central nervous system causes.
Unlike other forms of nausea, which tend to be mediated by dopamine and serotonin, vestibular system–induced nausea is mediated primarily by histamine and acetylcholine .
Although dopamine antagonists are inexpensive and have diffuse efficacy, they have an extensive side effect profile that includes sedation, orthostatic hypotension, and extrapyramidal symptoms such as tardive dyskinesia.6Rare reactions to dopamine antagonists include neuroleptic malignant syndrome and blood dyscrasias.
Because droperidol (Inapsine) has been associated with QT prolongation, 12-lead electrocardiography is recommended before treatment is initiated.
One small RCT18 in patients hospitalized because of hyperemesis gravidarum found that promethazine is as effective as ondansetron and is more cost-effective.Dopamine antagonists block dopamine in the intestines and chemoreceptor trigger zone; indications for these agents are similar to those for serotonin antagonists.