Discussion antiemetic discussion

[krsu]

so let's talk about antiemetic's,

everyone on this forum seems to agree that metoclopramide is the go-to antiemetic to be used alongside sn... why exactly is that?

I've been doing some research with my tiny little brain and here are three categories of commonly used antiemetics:

Surgery
(serotonin receptor blockers, dopamine receptor blockers, and some corticosteroids.)

• dexamethasone (Decadron)
• droperidol (Inapsine)
• granisetron
• metoclopramide (Reglan)
• ondansetron (Zofran)

Chemotherapy
(serotonin and dopamine receptor blockers, NK1 receptor blockers, and corticosteroids.)

• aprepitant (Emend)
• dexamethasone (DexPak)
• dolasetron (Anzemet)
• granisetron (Kytril)
• ondansetron (Zofran)
• palonosetron (Aloxi)
• prochlorperazine (Compazine)
• rolapitant (Varubi)

General nausea & Motion Sickness

• dimenhydrinate (Dramamine, Gravol)
• diphenhydramine (Benadryl)
• meclizine (Bonine)
• promethazine (Phenergan)

Sources used: www.medicalnewstoday.com

Stan's Guide lists these medications below as the recommended antiemetics to choose from:

1. Dromperidone
2. Metoclopramide
3. Olanzapine
4. Alizapramide
5. Chlorpromazine
6. Prochlorperazine

What makes metoclopramide supposedly so much better than all of these other drugs that I listed? From what I've read meto seems to be one of the riskier antiemetics due to the fact that it can cause permanent nervous system damage such as tardive dyskinesia.

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I personally want to discuss the option of using Promethazine as a antiemetic for those who have the easiest access to it and it seems to be very common.

The following information is sourced from: https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/promethazine

VI.B.6. Phenothiazines
Agents such as chlorpromazine, promethazine, prochlorperazine, and trimeprazine have a mixed pharmacology as antagonists at muscarinic, histaminergic, dopaminergic, adrenergic, and serotonergic receptors. Nausea and vomiting that fail to respond to specific pharmacologic treatments may sometimes respond to this multireceptor blockade (e.g., pregnancy sickness, PONV). Because the mechanisms mediating most types of nausea and vomiting are not clear but there may be many different contributory stimuli, the use of a mixed pharmacologic approach is logical. This may account for the extensive use of trimeprazine in palliative care.

Going off this information wouldn't this mean promethazine perfectly fits the description as an effective antiemetic to be used alongside SN?


Can we also discuss Benedryl (diphenhydramine)? It is an antihistamine that has antiemetic properties and is available over-the-counter.


P.S. Sorry if this post is looking kind of messy I'm writing it from my phone and suck at writing in general. This thread is not meant to start any arguments I just want people to be informed and also debate about how effective or how ineffective other alternatives are as antiemetics.

I found this!

https://sanctioned-suicide.net/thre...ntacid-beta-blockers-painkillers-draft.29822/

also admin can you please unban me from using the chat feature I'm sorry that I got angry and yelled at someone, I was having a bad day. I wish you would have just given me a warning :/


Love you guys <3
- krsu

 

[Deleted member 18655]

@krsu: Thanks! You have great timing.

I'm ready. This is great!

 

[krsu]

@krsu: Thanks! You have great timing.
View attachment 43336
I'm ready. This is great!

I'm just really curious myself and I'm hoping someone with more knowledge could give us some solid answers ;w; I did as much research on my own as I can but my brain can only understand so much >.>

 

[Racon]

Good thread idea. All this information really needs to be accurately compiled into one source. It can be far more confusing than the poisons themselves.

tardive dyskinesia

I would input that this isn't a problem due to the short length of time they will be used for.

More information appears to be needed on the anti-emetic properties of anti-psychotics. Particularly the usefulness of Aripiprazole (Abilify) as an atypical anti-psychotic with both dopamine agonist and antagonist properties.

On top of anti-psychotics, other drugs with anti-emetic attributes need to be identified and their usefulness determined. Off the top of my head there is Miratazapine.

Mirtazapine significantly improves pre-existing symptoms of nausea, vomiting, diarrhea, and irritable bowel syndrome in afflicted individuals.[97] Mirtazapine may be used as an inexpensive antiemetic alternative to Ondansetron

I am sure that people here would have a far easier time getting anti-depressants or anti-psychotics from a Doctor as many here legitimately need that stuff. As such I believe they ought to be focused on more than proper anti-emetics.

 

[Deleted member 18655]

Same here. There's no way I'm doing SN without and AE. I ordered some online but I don't know yet if it was a scam. I tried twice asking docs for meto for migraines and both said no. I have to research more and try again.

I am sure that people here would have a far easier time getting anti-depressants or anti-psychotics from a Doctor as many here legitimately need that stuff. As such I believe they ought to be focused on more than proper anti-emetics.

This would be easy to get! Mentioning COVID and sobbing about my life and I'll have an Rx in seconds.

 

[Busoccupant]

Great post.
I'm taking SN soon and I need antiemetics too. What about using antypsychotics? I really need help :(
I want to know if I can use aripiprazole as an antiemetic

https://sanctioned-suicide.net/threads/do-all-antipsychotics-work-as-antiemetics.47052/

 

[Checkmate3]

Benadryl has antiemetic properties? I bought it just in case, because supposedly it can treat EPS from Meto.

"The standard treatment for EPS is to take 50 mg of Diphenhydramine (Benadryl)"

 

[Deleted member 18655]

Benadryl has antiemetic properties? I bought it just in case, because supposedly it can treat EPS from Meto.

"The standard treatment for EPS is to take 50 mg of Diphenhydramine (Benadryl)"

I don't think they're strong enough at all. I take 3 Benadryl/Gravol each night to sleep, which probably isn't working anymore. I'd need something a lot stronger!

 

[krsu]

Great post.
I'm taking SN soon and I need antiemetics too. What about using antypsychotics? I really need help :(
I want to know if I can use aripiprazole as an antiemetic

https://sanctioned-suicide.net/threads/do-all-antipsychotics-work-as-antiemetics.47052/

Use of antipsychotic medication in chemotherapy-induced nausea and vomiting - PubMed

Nausea and vomiting continue to present significant problems for cancer patients undergoing chemotherapy. Initial work suggested an important role for central dopamine transmission in the underlying pathophysiology. However, recent evidence has implicated central and peripheral serotonin...

pubmed.ncbi.nlm.nih.gov

"Nausea and vomiting continue to present significant problems for cancer patients undergoing chemotherapy. Initial work suggested an important role for central dopamine transmission in the underlying pathophysiology. However, recent evidence has implicated central and peripheral serotonin release. Although the implementation of 5-HT(3) receptor antagonists has resulted in significant improvement in acute symptoms of nausea and vomiting, they have not demonstrated optimal efficacy in anticipatory and delayed emetic syndromes and are significantly more expensive than other antiemetic therapies. The use of typical antipsychotic medication to reduce nausea and vomiting in cancer patients is discussed, as is the potential efficacy of newer atypical antipsychotics, which have activity at receptors implicated in the control of chemotherapy-induced nausea and vomiting and demonstrate an improved side-effect profile.
"

 

[Checkmate3]

I would input that this isn't a problem due to the short length of time they will be used for.

So you can get "permanent nervous system damage such as tardive dyskinesia" only if you use Meto for a long time? Not just ones?

 

[krsu]

I don't think they're strong enough at all. I take 3 Benadryl/Gravol each night to sleep, which probably isn't working anymore. I'd need something a lot stronger!

The main reason I got into researching about benedryl (diphenhydramine) as an anti-emetic was from a former heroin user friend who recommended it to me to fix opioid induced nausea

 

[Racon]

So you can get "permanent nervous system damage such as tardive dyskinesia" only if you use Meto for a long time? Not just ones?

People take these multiple times a day for long periods without getting it. I'm sure it will be pretty low risk taking a few doses before you die from ctb.

 

[Checkmate3]

People take these multiple times a day for long periods without getting it. I'm sure it will be pretty low risk taking a few doses before you die from ctb.

You're right. EPS, or no EPS, it won't matter anyway. Of course if I fail and turn into a "walking seizure" it will suck, but not for long.

I'm sure it will be pretty low risk taking a few doses before you die from ctb.

And I will take only one dose of 30mg. No regime for me.

 

[krsu]

You're right. EPS, or no EPS, it won't matter anyway. Of course if I fail and turn into a "walking seizure" it will suck, but not for long.




And I will take only one dose of 30mg. No regime for me.

I'm just trying to figure out why everyone chooses metoclopramide over every other drug. I have some sources I could buy meto from but they are all international orders over clearnet and would probably take like 2-3 weeks to arrive to America. I was also looking into just ordering some from a darknet market but since the recent closure of the most popular one starting with an E, all of the new markets dont seem to have any meto in stock yet :(

 

[Deleted member 18655]

@krsu Is it easy for Americans to get pharmaceuticals from international sources? No U.S.-based company will ship to Canada because of Customs.

 

[krsu]

@krsu Is it easy for Americans to get pharmaceuticals from international sources? No U.S.-based company will ship to Canada because of Customs.

depends on the types of drugs, I have a decently large list of overseas clearnet pharmacies who ship to america, I've never had any packages seized yet

 

[VIBRITANNIA]

thanks for making this thread!

half of the anti-emetics stan listed have major interactions with the medication i take (citalopram / celexa). i know that there are some on the list that don't have any major interactions, but i'm curious as to why meto is the holy grail (if i'm even using that term right).

 

[Deleted member 18655]

@VIBRITANNIA i don't understand something: if you're going to ctb with the intent of succeeding, what difference would it make for interactions? Other than making you vomit, what side effects are you aiming to avoid?

 

[krsu]

I've seen people have been saying benedryl is too weak to be an effective antiemetic for SN but I want to know why you think this? Is there anything to back this up? You can always take more than the recommended dose obviously to improve its antiemetic effects

@VIBRITANNIA i don't understand something: if you're going to ctb with the intent of succeeding, what difference would it make for interactions? Other than making you vomit, what side effects are you aiming to avoid?

they probably want to avoid an unpleasant death if there is bad interactions

 

[Deleted member 18655]

I found this!

https://sanctioned-suicide.net/thre...ntacid-beta-blockers-painkillers-draft.29822/

 

[krsu]

I found this!

https://sanctioned-suicide.net/thre...ntacid-beta-blockers-painkillers-draft.29822/

Going off that guide you just linked that means promethazine should work fine as an antiemetic for sn?
In it OP states that for it to be an effective antiemetic for SN it must target dopamine and "preferably" serotonin as well

Here's a quote from an article I read just now:

VI.B.6. Phenothiazines
Agents such as chlorpromazine, promethazine, prochlorperazine, and trimeprazine have a mixed pharmacology as antagonists at muscarinic, histaminergic, dopaminergic, adrenergic, and serotonergic receptors. Nausea and vomiting that fail to respond to specific pharmacologic treatments may sometimes respond to this multireceptor blockade (e.g., pregnancy sickness, PONV). Because the mechanisms mediating most types of nausea and vomiting are not clear but there may be many different contributory stimuli, the use of a mixed pharmacologic approach is logical. This may account for the extensive use of trimeprazine in palliative care.
Source: https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/promethazine

 

[bigoof77]

This looks promising

 

[krsu]

still waiting on someone to explain why benedryl (diphenhydramine) would make a bad anti-emetic... my only thought is because maybe its a H1 histamine and not an H2 histamine

https://www.ncbi.nlm.nih.gov/books/NBK533003/

 

[krsu]

The whole point of this thread was to discuss and debate alternative antiemetic options for use with SN, so if I'm wrong here please tell me why, this stuff isn't discussed enough and I'd like to learn the actual reasoning behind things.

So far (from what I've think I've learned) a good alternative for metoclopramide would be promethazine, it fits the description to be a suitable anti-emetic to be used alongside SN and it is a lot easier to get ahold of too.

A friend and I recently found out we had ondansetron laying around in our medicine cabinets and I assumed that since it was listed alongside metoclopramide as another antiemetic used for surgery, that's not the case actually... ondansetron is NOT suitable to be used with SN because it doesnt block the dopamine receptors.

Is promethazine a dopamine antagonist? Yes.

"Promethazine is used to treat N&V and motion sickness. Promethazine is also used as a sedative-hypnotic because of its ability to block dopamine receptors. Allergic reactions caused by histamine release may be treated by promethazine through blocade of histamine receptors (H1 subtype)."
source: journals.lww.com

"Promethazine is a phenothiazine derivative first-generation H1 receptor antagonist but is also an antagonist at muscarinic (M1) and dopamine (D2) receptors."
source: www.sciencedirect.com

Is ondansetron a dopamine antagonist? No.

"Ondansetron is a highly specific and selective serotonin 5-HT3 receptor antagonist, with low affinity for dopamine receptors."
source: en.m.wikipedia.org

"Zofran (ondansetron) and Reglan (metoclopramide) belong to different antiemetic drug classes. Zofran is a selective 5-HT3 receptor antagonist and Reglan is a dopamine antagonist."
source: www.rxlist.com

Sorry if this information seemed obvious to everyone, it wasn't obvious for me and I just wanted to try and help others because everyone seems to believe you HAVE to have metoclopramide to make this work which isn't true.

love all of you ♥

 

[not4us]

Seems you explored the topic in depth. Thank you for sharing your thoughts. What do you think about Domperidone? Is it good enough for SN? Or maybe worse than other alternatives?

 

[krsu]

Seems you explored the topic in depth. Thank you for sharing your thoughts. What do you think about Domperidone? Is it good enough for SN? Or maybe worse than other alternatives?

Looks like it should be good to use domp, its actually very similar to metoclopramide

 

[Meditation guide]

Since everyone vomits anyway why take an antiemetic at all?

 

[krsu]

Since everyone vomits anyway why take an antiemetic at all?

I'm sorry but do you have evidence of this? if you properly dose anti-emetics and antiacids you shouldn't puke

even if you vomited anyways the anti-emetics would should hopefully atleast delay that reaction long enough for enough sn to get into your bloodstream

 

[Meditation guide]

I'm sorry but do you have evidence of this?

I don't have actual videos of everyone who ever took SN so no I don't have evidence. I didn't know this was a courtroom. I'm sorry but when I make a simple statement I don't expect to be asked if I have evidence. I seem to always be put into a position of having to defend what I say for some reason. I guess I assume everyone was following all the many threads where people here have taken SN.

 

[krsu]

I don't have actual videos of everyone who ever took SN so no I don't have evidence. I didn't know this was a courtroom.

I just don't get why you are saying don't bother with antiemetics when clearly they help