Treatment of nausea with innovative antiemetics

ABSTRACT Introduction: The understanding of neuroanatomy in emetic pathway has been re-evaluated recently, and the pharmacological care of patients, who suffer from cancer-related nausea and vomiting, has dramatically changed. Areas covered: This review will focus on innovative antiemetics in both aspects of basic pharmacology and evidence-based medicine by latest literatures in the palliative care field. Expert commentary: Although a number of studies have evaluated the clinical effectiveness of traditional antiemetics, such as metoclopramide, recommendations of these antiemetics are very weak due to a lack of well-designed randomized-control trials. Newer antiemetics have shown potential efficacy for the treatment of refractory nausea, which is non-responsive to traditional antiemetics. Olanzapine, asenapine, and mirtazapine are novel antipsychotics that target multiple neurotransmitter receptors, leading to a superior therapeutic outcome and fewer side effects. Cannabinoids can be said to be ‘innovative’ when used in this manner. Although this class of drugs has a possibility to effectively treat cancer-related emesis, major adverse effects were observed in recent systematic reviews and may limit its clinical application. Kampo medicines are widely used in Japan for the relief of gastrointestinal symptoms related to advanced cancer, and their mechanism of action is gradually becoming better understood. Innovative antiemetics are highly anticipated medications, and further investigations are warranted.