The following drugs, demonstrated to have limited utility in the N and V secondary to the following indications, have been proposed for use in refractory nausea and vomiting :

a. Gabapentinoids – chemotherapy related nausea and vomiting, postoperative nausea.

b. Mirtazapine – gastroparesis

c. Inhaled Isopropyl alcohol – postoperative setting and emergency,

Formulation- Taking more than equal to 3 deep inspirations from a skin cleansing swab containing 70 percent drug held directly below the nostrils, and repeating it after 15 minutes if required. Mechanism of action unknown, acted more quickly and reduced need for additional antiemetics, when compared to ondansetron in 4 RCTs in Nausea in the Emergency setting.

Other drugs that have been shown to have utility in this setting include Aprepitant, clonidine, nabilone and propofol (GABAmimetic).

References

Wilcock, A., Howard, P., Toller, C. S., Droney, J., & Charlesworth, S. (Eds.). (2025). Palliative care formulary (9th ed.). Pharmaceutical Press.