The Vomiting Center and CTZ

Vomiting is a complex reflex action that involves multiple areas of the brain and various neurotransmitter systems. Central to this process are the Vomiting Center (VC) and the Chemoreceptor Trigger Zone (CTZ). Let’s delve deeper into their roles, the receptors involved, and their significance in conditions like postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV).

CTZ and Vomiting center
#CTZ and Vomiting center
CTZ role in Nausea and Vomiting

1. Vomiting Center (VC)

The VC is located in the medulla oblongata of the brainstem. It is the primary center responsible for inducing the act of vomiting. The VC receives inputs from various sources, including the CTZ, the gastrointestinal tract, the vestibular system, and higher brain centers.

2. Chemoreceptor Trigger Zone (CTZ)

The CTZ is situated in the area postrema of the medulla oblongata, outside the blood-brain barrier. This unique location allows it to detect circulating toxins and drugs in the blood. The CTZ has various receptors that, when activated, send signals to the VC to initiate vomiting.

Receptors in the CTZ include:

  • Dopamine (D2) Receptor: Activation can lead to nausea and vomiting. Drugs like metoclopramide and domperidone block these receptors to reduce nausea and vomiting.
  • Serotonin (5-HT3) Receptor: Commonly activated by chemotherapy agents. Ondansetron and granisetron are examples of drugs that block these receptors.
  • Neurokinin (NK1) Receptor: Aprepitant and fosaprepitant are drugs that block this receptor.
  • Muscarinic Receptor: Scopolamine acts on this receptor.
  • Histamine (H1) Receptor: Drugs like promethazine act on this receptor.

3. Postoperative Nausea and Vomiting (PONV)

PONV is a common complication after surgery. The exact mechanism is multifactorial, involving anesthetic agents, type of surgery, and individual patient factors.

Drugs used for PONV include:

  • Ondansetron: A 5-HT3 receptor antagonist.
  • Dexamethasone: A corticosteroid.
  • Scopolamine: An anticholinergic.
  • Metoclopramide: A dopamine antagonist.

4. Chemotherapy-Induced Nausea and Vomiting (CINV)

CINV is a distressing side effect of many chemotherapy agents. The severity depends on the type of chemotherapy, dose, and individual patient factors.

Drugs used for CINV include:

  • Ondansetron and Granisetron: 5-HT3 receptor antagonists.
  • Aprepitant and Fosaprepitant: NK1 receptor antagonists.
  • Dexamethasone: A corticosteroid.
  • Metoclopramide: A dopamine antagonist.

5. Pregnancy Induced Nausea and Vomiting (PINV)

Pregnancy-induced nausea and vomiting, commonly known as morning sickness, affects a significant number of pregnant women, especially during the first trimester. While the exact cause remains unclear, it’s believed that hormonal changes, particularly the rise in human chorionic gonadotropin (hCG) and estrogen, play a role.

Drugs used for PINV:

  1. Dietary and Lifestyle Changes: Consuming smaller, more frequent meals and avoiding spicy or fatty foods can help. It’s also beneficial to eat dry toast or crackers before getting out of bed in the morning.
  2. Vitamin B6 (Pyridoxine): This vitamin can help reduce nausea during pregnancy. It’s often recommended as a first-line treatment.
  3. Doxylamine: An antihistamine that, when combined with vitamin B6, can be effective for treating PINV. This combination is available as an over-the-counter drug in some countries.
  4. Ginger: Some studies have shown that ginger can be effective in reducing nausea during pregnancy. It can be consumed as ginger tea, capsules, or biscuits.
  5. Antiemetic Drugs: If the above measures are ineffective, doctors might prescribe antiemetic drugs like metoclopramide or ondansetron. However, it’s essential to discuss potential risks and benefits with a healthcare provider.

It’s crucial to note that while PINV is uncomfortable, it’s usually not harmful to the mother or baby. However, in severe cases, where a woman can’t keep any food or drink down, she might develop a condition called hyperemesis gravidarum, which requires medical attention.

6. Sea Sickness and Motion Sickness

Sea sickness and motion sickness are both forms of a condition known as vestibular system disturbance. Essentially, they occur when there’s a mismatch between the information the brain receives from the inner ear balance mechanism and what the eyes see. While sea sickness is specifically related to the motion of a boat or ship, motion sickness can be triggered by any form of movement, including car rides, flights, or even amusement park rides.

Understanding the Mechanism:

The inner ear, specifically the vestibular system, helps us maintain our balance and sense of spatial orientation. When the motion we sense with our inner ear is different from the motion we visualize, it can lead to symptoms of motion sickness.


Common symptoms of sea sickness and motion sickness include:

  • Nausea
  • Vomiting
  • Dizziness
  • Sweating
  • A general sense of feeling unwell

Drugs Used for Treatment:

  1. Antihistamines: These are the most commonly used medications for motion sickness. They work by blocking the action of histamine, which can lead to symptoms of motion sickness.
    • Dimenhydrinate (Dramamine): Available over-the-counter (OTC), it’s one of the most commonly used drugs for motion sickness. It’s best taken before the start of a journey.
    • Meclizine (Antivert, Bonine): Another OTC option, it’s less sedating than dimenhydrinate.
  2. Scopolamine (Transderm Scop): This is a prescription patch that’s placed behind the ear. It’s a type of anticholinergic drug and is effective in preventing sea sickness and motion sickness. The patch is applied about 4 hours before the journey and can be effective for up to 3 days.
  3. Ginger: While not a drug, ginger has been found to be effective in preventing and treating motion sickness. It can be taken as capsules, tea, or even in its raw form.
  4. Cinnarizine (Stugeron): This is an antihistamine specifically used for motion sickness and vertigo. It’s not available in the U.S. but is commonly used in other parts of the world.
  5. Promethazine (Phenergan): This prescription drug is effective for motion sickness but can be quite sedating. It’s usually taken 1-2 hours before the journey.

Preventive Measures:

Apart from medications, there are several strategies one can adopt to prevent or minimize the effects of motion sickness:

  • Choose a seat where motion is felt least. For instance, in a car, the front seat is preferable, while on a ship, a cabin in the middle of the boat and near the waterline can help.
  • Avoid reading while moving.
  • Keep your gaze fixed on the horizon or a distant stationary object.
  • Ensure adequate ventilation and avoid strong odors.
  • Lie down if possible.
  • Avoid heavy meals before and during travel.

Sea sickness and motion sickness, while uncomfortable, are usually not serious and can be managed effectively with medications and preventive measures. If you’re prone to motion sickness, it’s advisable to be prepared before embarking on any journey, especially if it involves prolonged movement. Always consult with a healthcare professional before taking any medication.

7. Conclusion

In conclusion, the Vomiting Center and the Chemoreceptor Trigger Zone play pivotal roles in the vomiting reflex, whether it’s due to surgery, chemotherapy, or pregnancy. Understanding their mechanisms and the receptors involved is crucial for effective management. Modern antiemetic drugs target specific receptors in the CTZ, providing relief to patients and improving their quality of life.

Disclaimer: This article is for informational purposes only and should not be taken as medical advice. Always consult with a healthcare professional before making any decisions related to medication or treatment.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of a healthcare provider with any questions regarding a medical condition.

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