Antiemetics used for prophylaxis and treatment of postoperative nausea and vomiting^[1-4]

Drug	Dose^[1]	Timing	Comments
Adults
Glucocorticoid
Dexamethasone	IV: 4 to 8 mg	After induction of anesthesia
Serotonin (5-HT₃) receptor antagonists
Ondansetron	IV: 4 mg	IV: End of surgery	May prolong QT interval. ODT or oral soluble film may also be useful for PDNV.
Ondansetron	Oral: 8 mg (ODT or film)	Oral: 30 to 60 minutes prior to surgery
Granisetron	IV: 0.35 to 3 mg	End of surgery	May prolong QT interval.
Dolasetron^*	IV: 12.5 mg	End of surgery	May prolong QT interval.
Tropisetron^*	IV: 2 mg	End of surgery	May prolong QT interval.
Palonosetron	IV: 0.075 mg	At induction of anesthesia
Anticholinergic
Scopolamine	Transdermal patch: 1.5 mg	Apply several hours (eg, ≥2 hours) before anesthesia	Remove 24 hours after surgery.
Antidopaminergics
Droperidol	IV: 0.625 to 1.25 mg	At the end of surgery	May prolong QT interval; per FDA recommendation, monitor ECG for 2 to 3 hours after administration.
Haloperidol	IV, IM, oral: 1 mg	At the end of surgery	May prolong QT interval.
Amisulpride	IV, prevention: 5 mg	Prevention: At induction of anesthesia	Administer over 1 to 2 minutes. May prolong QT interval.
Amisulpride	IV, treatment: 10 mg		Administer over 1 to 2 minutes. May prolong QT interval.
Neurokinin 1 receptor antagonists
Aprepitant	Oral: 40 mg	Preoperative	May reduce efficacy of hormonal contraceptives.
Aprepitant	IV: 32 mg over 30 seconds	Preoperative	May reduce efficacy of hormonal contraceptives.
Fosaprepitant	IV: 150 mg	Preoperative	May reduce efficacy of hormonal contraceptives.
Rolapitant	Oral: 90 mg	Preoperative	Long half-life; useful for prevention of PDNV.
Antihistamines
Dimenhydrinate	IV: 1 mg/kg (maximum single dose: 100 mg)	Optimal timing not established
Diphenhydramine	IV: 1 mg/kg (maximum single dose: 100 mg)	Optimal timing not established
Children
Glucocorticoid
Dexamethasone	IV: 0.15 to 0.25^[2] mg/kg (maximum dose: 4 mg)	After induction
Serotonin (5-HT₃) receptor antagonists
Ondansetron	IV: 0.1 mg/kg (maximum dose: 4 mg)	IV: End of surgery	May repeat dose for postoperative vomiting rescue; maximum total perioperative dose: 8 mg. ODT or oral soluble film may also be useful for PDNV^[3].
Ondansetron	Oral, children over 5 years of age^[3]: 4 mg (ODT or film)	Oral: 30 to 60 minutes prior to surgery
Granisetron	IV: 40 mcg/kg (maximum dose: 0.6 mg)	Optimal timing not established	QT prolongation has been observed in pediatric patients 2 to 16 years of age.
Dolasetron^*	IV: 0.35 mg/kg (maximum dose: 12.5 mg)	End of surgery
Antihistamines
Dimenhydrinate	IV: 0.5 mg/kg IV (maximum dose: 25 mg)	Optimal timing not established
Diphenhydramine	IV: 0.5 mg/kg IV (maximum dose: 25 mg)	Optimal timing not established

Combination therapy using different classes of drugs is usually more effective than single-drug therapy for PONV prophylaxis in both children and adults. For rescue therapy after anesthesia, treatment should include a drug from a different class than those that have already been administered unless the effect of the first drug has likely worn off or a potentially inadequate dose has been administered. For additional information including administration, precautions, and drug interactions, refer to the relevant clinical topics and Lexicomp drug monographs and Lexicomp drug interactions program included within UpToDate.

ECG: electrocardiogram; FDA: United States Food and Drug Administration; IM: intramuscular; IV: intravenous; ODT: orally disintegrating tablet; PDNV: post-discharge nausea and vomiting; PONV: postoperative nausea and vomiting.

* Not available in the United States.

References:

Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020; 131:411-448.
Madan R, Bhatia A, Chakithandy S, et al. Prophylactic dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: a dose ranging and safety evaluation study. Anesth Analg 2005; 100:1622.
Davis PJ, Fertal KM, Boretsky KR, et al. The effects of oral ondansetron disintegrating tablets for prevention of at-home emesis in pediatric patients after ear-nose-throat surgery. Anesth Analg 2008; 106:1117.

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Antiemetics used for prophylaxis and treatment of postoperative nausea and vomiting[1-4]

Antiemetics used for prophylaxis and treatment of postoperative nausea and vomiting^[1-4]