Which class of antiemetics should be used with caution in patients with a history of seizures?

Dopamine antagonists, such as metoclopramide and prochlorperazine, are the class of antiemetics that require caution in patients with a history of seizures. This is primarily due to their potential to lower the seizure threshold. Dopamine plays a complex role in neurotransmission, and medications that block dopamine receptors can lead to alterations in central nervous system activity, which may precipitate seizures in susceptible individuals.

For patients with a seizure history, care must be taken to assess the risk versus the benefit of using these agents. Non-dopaminergic antiemetics, such as serotonin receptor antagonists, antihistamines, or anticholinergics, do not carry the same level of concern regarding seizure risk and can often be safer alternatives for managing nausea and vomiting in these patients.