General purpose vomit response control?

Question

Is there a general purpose antiemetic for vomit response control? Many vomit control solutions are focused on specific causes for the vomiting. Some common causes of nausea/vomiting:

• Cancer treatments
• Upset stomach/gastric distress
• Dehydration
• Motion sickness
• Gastroenteritis
• Pregnancy
• Alcohol

What I'm interested in is medicines or methods to suppress the vomit response in general, or at least cover a broad range of causes. Does such a thing exist?

Answer 1

Physiology, Chemoreceptor Trigger Zone (StatPearls):

Nausea and vomiting are controlled by the vomiting center in the medulla oblongata, which is located between the brainstem and spinal cord. The main part of the vomiting center is the chemoreceptor trigger zone (CTZ), also known as the area postrema (AP), which receives signals from:

• the blood (uremia, ketoacidosis, hypoxia, opiates, cancer chemotherapy...)
• gastrointestinal tract (gastroenteritis or gastroparesis - signals travel via autonomic nerve fibers)
• the vestibular system (motion sickness, inner ear disorders)
• centers in the brain cortex and thalamus (pain, smells, psychological causes...)

Picture: Signals that induce vomiting (source: Pharma Study World)

So, theoretically, there could be an antiemetic that would "block" the vomiting center and thus relieve nausea from any cause...

...yet, there are no ideal and universal antiemetics available in the clinics because the existing antiemetics target only one or a few stimuli that trigger the reflex. (International Journal of Pharmacy and Pharmaceutical Sciences, 2019)

Anyway, certain antiemetics can be used to relieve nausea from more than one cause (here: Table 2):

Indications for antiemetics:

1. 5-HT3 antagonists: ondansetron and palonosetron for chemotherapy-induced and posoperative nausea
2. D2 Antagonists:
   • Phenothiazines, such as prochlorperazine, for nausea associated with motion sickness, migraine, radiotherapy, chemotherapy, postoperative, viral gastroenteritis, and severe morning sickness during pregnancy
   • Butyrophenones, such as droperidol and olanzapine, for nausea associated with cancer chemotherapy and postoperative nausea associated with opioids.
3. H1 antagonists: promethazine and dimenhydramine for motion sickness and morning sickness in pregnancy
4. ACh (M) antagonists (anticholinergics): L-hyoscine as a transdermal patch for prophylaxis of motion sickness
5. Synthetic cannabinoids: dronabinol and nabilone for nausea associated with chemotherapy and radiotherapy in patients who have failed to respond to the other antiemetics
6. Corticosteroids: dexamethasone for chemotherapy-induced nausea and for severe morning sickness
7. SP/NK1 antagonists: aprepitant for postoperative and chemotherapy-induced nausea (in combination with dexamethasone)