On Natural Anti-Emetics

Last July I posted on audiovestibular symptoms, not exclusively but also related to Sjogren's syndrome, and anti-emetics/balance therapy as an aid for fixing balance and nausea issues. The post was very insightful and deserves a revisiting HERE. In any case I had promised to look a bit deeper on natural anti-emetics since anti-emetic drugs trigger secondary effects more frequently than natural products. These can be used as a good approach to correct developed symptoms arising from audiovestibular complications. Before we proceed, a very important disclaimer: If you or anyone you know is going through any medical event that can relate to the information hereby shared, please do not take such information as medical advice. The current post, as any other post in The Toxicologist Today blog is purely for scientific information; exclusively to the use of the reader in growing a better knowledge of the science surrounding the different debated topics. This information does not intend to support any clinical or medical decision, but to enhance your capacity to discuss scientific topics based on real scientific publications/references.

What are anti-emetics?

Anti-emetics are substances that can prevent or arrest nausea and emesis (vomiting). They can be classified into different pharmaceutical types. Drugs falling within this category should only be prescribed when the underlying reasons for nausea and vomiting are known, otherwise their action could be masking more serious conditions that can develop in the background with no adequate diagnosis conducted. The range of secondary effects that are known to occur when taking anti-emetics are non-extensively listed in a very good post by Medical News Today (Access HERE). [1].

Different pharmaceuticals (e.g., antihistamines, phenothiazines, Bismuth-subsalicylate, cannabinoids, corticosteroids, dopamine receptor blockers, NK1 receptor blockers, serotonin receptor blockers, etc) are specifically indicated according to the causation (aetiology) of the condition, but its use can be followed by different secondary effects. For a lengthier look into the different treatment possibilities you can visit NICE's page on the matter that contains excellent content (access HERE) [2]. 

Some of these products are used for controlling post-surgery symptoms. Others address 'simpler' cases like gastroenteritis, or for counteracting sickness in pregnancy due to, for example, certain endocrine levels in the female body. Some other products are intended to counteract iatrogenic nausea and vomiting urges that are related to the use of immunomodulatory drugs (as it is the case in chemotherapy treatments).

How do anti-emetics work?

Very simply put they basically block certain neurotransmitters (like serotonin receptor blockers and dopamine receptor blockers, for example) found in the body and that are related to the triggering of nausea and vomiting impulses.

What natural anti-emetics are available?

Ginger (Zingiber officinale) is a root known for holding very potent anti-emetic properties and does not lack scientific support of its capacity to reduce nausea in different scenarios, such as in pregnancy [3],  prophylaxis in day case surgery [4], in the reduction of nausea and mild emesis induced by chemotherapy [5].

Peppermint (Mentha piperita, spicata) inhalation/aromatherapy is believed to possess anti-emetic properties when tested against postoperative nausea or chemotherapy-induced nausea, however some authors think it might be more related to the assumed breathing patterns rather than the inhaled substance itself [6] or that the herb should be used as an adjunct prophylactic rather than the principal therapy [7] [8].

Cinnamon (Cinnamomum zeylanicum) has also been pointed as showing anti-emetic properties when compared to known synthetic drugs [9], and especially on systemic symptoms associated to menstrual bleeding, that do account for the possibility of nausea and vomiting [10].

[1] What are the best ways to get rid of nausea, Medical News Today, [https://www.medicalnewstoday.com/articles/320877.php], Last visited on the 16-Aug-2019, last updated on the 10th of February 2018.

[2] Nausea and Labyrinth Disorders, NICE National Institute for Health and Care Excellence, [https://bnf.nice.org.uk/treatment-summary/nausea-and-labyrinth-disorders.html], last visited on the 16th of August 2019, last update unknown.

[3] Viljoen, E., Visser, J., Koen, N. et al (2014). "A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting". Nutrition Journal, 13 (20), pp. 2-14.

[4] Phillips, S., Ruggier, R., Hutchinson, S. E. (1993). "Zingiber officinale (Ginger)–an antiemetic for day case surgery". Anaesthesia, 48, pp. 715-717.

[5] Sontakke, S., Thawani, V., Naik, M. S. (2003). "Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double blind study". Indian Journal of Pharmacology, 35, pp. 32-36.  

[6] Lynn, A., Anderson, R. N., Gross, J. B. et al (2003). "Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea". Journal of PeriAnesthesia Nursing, 19 (1), pp. 29-35.

[7] Lane, B., Cannella, K., Bowen, C.  (2011). "Examination of the Effectiveness of Peppermint Aromatherapy on Nausea in Women Post C-Section ". Journal of Holistic Nursing, 30(2), pp. 90-104.

[8] Tayarani-Najaran,Z., Talasaz-Firoozi, E., Nasiri, R., et al (2013). "Antiemetic activity of volatile oil from Mentha spicata and Mentha × piperita in chemotherapy-induced nausea and vomiting". Ecancermedicalscience. 7 (290).

[9] Khan, I. A., Aziz, A., Sarwar, H. S. (2014). "Evaluation of antiemetic potential of aqueous bark extract of cinnamon". Canadian journal of applied sciences, 4(1), pp. 26-32.

[10] Jaafarpour, M., Hatefi, M., Najafi, F. et al (2015). "The Effect of Cinnamon on Menstrual Bleeding and Systemic Symptoms With Primary Dysmenorrhea". Iran Red Crescent Med J., 17(4).

1st image Caglar Araz on Unsplash

2nd image by Dominik Martin on Unsplash