What is the role of antiemetic therapy in the emergency treatment of nephrolithiasis?

Updated: Sep 16, 2021
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Because nausea and vomiting frequently accompany acute renal colic, antiemetics often play a role in renal colic therapy. Several antiemetics have a sedating effect that is often helpful.

Metoclopramide is the only antiemetic that has been specifically studied in the treatment of renal colic. In 2 double-blinded studies, it apparently provided pain relief equivalent to narcotic analgesics in addition to relieving nausea. Its antiemetic effect stems from its dopaminergic receptor blockage in the CNS. It has no anxiolytic activity and is less sedating than other centrally acting dopamine antagonists. The effect of metoclopramide begins within 3 minutes of an IV injection, but it may not take effect for as long as 15 minutes if administered IM.

The usual dose in adults is 10 mg IV or IM every 4-6 hours as needed. Metoclopramide is not available as a suppository.

Other medications commonly used as antiemetics include ondansetron, promethazine, prochlorperazine, and hydroxyzine. The author usually recommends antiemetics when patients with renal colic have been vomiting actively or report nausea sufficient to interfere with oral therapy. They also may be useful as anxiolytics in some cases. Ondansetron can provide a useful tool for both emergency room settings as well as at home as it is available in multiple forms including IV, dissolvable tablet, solution and pill form. It has now become the drug of choice for nausea associated with renal colic though is contraindicated in patients with QT prolongation.

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