Amisulpride (Barhemsys) is a dopamine antagonist and is currently the only antiemetic approved for rescue treatment of PONV after failed prophylaxis. Barhemsys is indicated in adults for both the prevention and treatment of postoperative nausea and vomiting (PONV), either alone or in combination with an antiemetic of a different class. This medication causes dose- and concentration-dependent prolongation of the QT interval, so caution is advised, especially in patients with certain pre-existing conditions or taking medications that may affect cardiac conduction. Common adverse reactions include chills, hypokalemia, procedural hypotension, and abdominal distention. Barhemsys should be avoided in patients with severe renal impairment, and caution is recommended in lactating women due to increased serum prolactin levels.
- For adults, The recommendation for rescue treatment is a single IV 10-mg dose administered over 1 to 2 minutes
When PONV emerges in PACU or operating room, the protocol for rescue treatment suggests opting for a drug from a different class than those already administered, unless the initial drug's effect has dissipated or an insufficient dose may have been given. Serotonin receptor antagonists (such as Zofran) stand out as particularly beneficial rescue medications in the PACU, particularly for patients undergoing same-day surgery, given their non-sedating nature. In cases of opioid-induced PONV or postoperative vomiting (POV), a low-dose naloxone infusion (0.25 mcg/kg/hour IV) can mitigate opioid-induced side effects like nausea and vomiting without compromising analgesia.
