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Cancer Control : Journal of the Moffitt... Apr 2012Chemotherapy-induced nausea and vomiting (CINV) is one of the most debilitating toxicities associated with cancer treatment. Although effective antiemetic agents are... (Review)
Review
BACKGROUND
Chemotherapy-induced nausea and vomiting (CINV) is one of the most debilitating toxicities associated with cancer treatment. Although effective antiemetic agents are available, their use in practice often is suboptimal.
METHODS
The author reviews the pathophysiology of CINV as well as the drug classes and cost considerations that should be incorporated into treatment planning.
RESULTS
Several drug classes, including 5-hydroxytryptamine-3 receptor antagonists, neurokinin-1 receptor antagonists, and corticosteroids, are effective, especially when used in combination. Older antiemetic agents, such as prochlorperazine and metoclopramide, as well as olanzapine may provide reasonable alternatives in certain settings.
CONCLUSIONS
Interventions for CINV should include standard-of-care antiemetics combined with corticosteroids. The cost of using older, less expensive antiemetics may be outweighed by the expenditures to rescue patients after suboptimal prophylaxis, as well as the indirect costs of missed work and lost productivity.
Topics: Antiemetics; Antineoplastic Agents; Humans; Metoclopramide; Nausea; Prochlorperazine; Vomiting
PubMed: 22488022
DOI: 10.1177/107327481201902s02 -
Journal of Medicine and Life 2020Nausea is a mental sensation of unease and discomfort before vomiting. Vomiting refers to the return of the contents of the upper gastrointestinal tract to the mouth... (Comparative Study)
Comparative Study Randomized Controlled Trial
Nausea is a mental sensation of unease and discomfort before vomiting. Vomiting refers to the return of the contents of the upper gastrointestinal tract to the mouth caused by contractions of chest and abdomen muscles. Postoperative nausea and vomiting is an unpleasant experience with high treatment costs. Therefore, this study aimed to compare the effects of haloperidol, metoclopramide, dexmedetomidine, and ginger on postoperative nausea and vomiting after laparoscopy. This double-blind clinical trial was performed on all laparoscopy candidates at Valiasr hospital, Arak, Iran. The patients were randomly divided into four groups (haloperidol, metoclopramide, dexmedetomidine and ginger), and all patients underwent general anesthesia using fentanyl, midazolam, atracurium, and propofol. After intubation, tube fixation, and stable hemodynamic conditions, the patients received four ginger capsules with a hint of lemon. A group of patients received 25 μg of dexmedetomidine. In the Plasil group, 10 mg of metoclopramide was given 30 minutes before the completion of surgery. In addition, 0.5 cc of haloperidol (5 mg) was administered to a group of patients. Heart rate, blood pressure, and oxygen saturation were recorded from the beginning of surgery, every 15 minutes until the end of the surgery. Furthermore, the occurrence of nausea and vomiting was recorded during recovery, 2 and 4 hours after surgery. Data were then analyzed using the SPSS software v.23. Eighty-eight patients were enrolled in the study. The youngest and the oldest were 30 years and 70 years old, respectively, and the mean age was 48.02 ± 9.31 years. Moreover, the number of women in the four groups was higher than that of men. Blood pressure in the dexmedetomidine group was lower than the other four groups (P <0.05). The lowest heart rate was observed in the haloperidol group, while the highest heart rate was seen in the plasil group (P <0.05). The occurrence of vomiting and nausea was not significantly different between the four groups (P <0.05). Our results showed no significant difference in postoperative nausea and vomiting between the four drugs. Due to the hemodynamic changes induced by each drug, it is best to use these drugs based on the patient's condition. Ginger is also a herbal remedy that has fewer side effects, and this drug can be a good option for patients when there is no contraindication.
Topics: Adult; Aged; Blood Pressure; Cholecystectomy, Laparoscopic; Dexmedetomidine; Double-Blind Method; Female; Zingiber officinale; Haloperidol; Humans; Iran; Male; Metoclopramide; Middle Aged; Oxygen; Plant Extracts; Postoperative Nausea and Vomiting
PubMed: 32742515
DOI: 10.25122/jml-2019-0070 -
Xenobiotica; the Fate of Foreign... Apr 20141. Metoclopramide is a widely used clinical drug in a variety of medical settings with rare acute dystonic events reported. The aim of this study was to assess a...
1. Metoclopramide is a widely used clinical drug in a variety of medical settings with rare acute dystonic events reported. The aim of this study was to assess a previous report of inactivation of CYP2D6 by metoclopramide, to determine the contribution of various CYPs to metoclopramide metabolism, and to identify the mono-oxygenated products of metoclopramide metabolism. 2. Metoclopramide interacted with CYP2D6 with Type I binding and a Ks value of 9.56 ± 1.09 µM. CYP2D6 was the major metabolizer of metoclopramide and the two major products were N-deethylation of the diethyl amine and N-hydroxylation on the phenyl ring amine. CYPs 1A2, 2C9, 2C19, and 3A4 also metabolized metoclopramide. 3. While reversible inhibition of CYP2D6 was noted, CYP2D6 inactivation by metoclopramide was not observed under conditions of varying concentration or varying time using Supersomes(TM) or pooled human liver microsomes. 4. The major metabolites of metoclopramide were N-hydroxylation and N-deethylation formed most efficiently by CYP2D6 but also formed by all CYPs examined. Also, while metoclopramide is metabolized primarily by CYP2D6, it is not a mechanism-based inactivator of CYP2D6 in vitro.
Topics: Cytochrome P-450 CYP2D6; Cytochrome P-450 CYP2D6 Inhibitors; Dopamine Antagonists; Humans; Hydroxylamine; Hydroxylation; Kinetics; Ligands; Liver; Metoclopramide; Microsomes, Liver; Models, Molecular; Molecular Docking Simulation; Recombinant Proteins
PubMed: 24010633
DOI: 10.3109/00498254.2013.835885 -
The American Journal of Emergency... Jan 2021Due to the healthcare burden associated with migraines, prompt and effective treatment is vital to improve patient outcomes and ED workflow. This was a prospective,... (Randomized Controlled Trial)
Randomized Controlled Trial
Due to the healthcare burden associated with migraines, prompt and effective treatment is vital to improve patient outcomes and ED workflow. This was a prospective, randomized, double-blind trial. Adults who presented to the ED with a diagnosis of migraine from August of 2019 to March of 2020 were included. Pregnant patients, or with renal impairment were excluded. Patients were randomized to receive intravenous magnesium, prochlorperazine, or metoclopramide. The primary outcome was change in pain from baseline on a numeric rating scale (NRS) evaluated at 30 min after initiation of infusion of study drug. Secondary outcomes included NRS at 60 and 120 min, ED length of stay, necessity for rescue analgesia, and adverse effects. A total of 157 patients were analyzed in this study. Sixty-one patients received magnesium, 52 received prochlorperazine, and 44 received metoclopramide. Most patients were white females, and the median age was 36 years. Hypertension and migraines were the most common comorbidities, with a third of the patients reporting an aura. There was a median decrease in NRS at 30 min of three points across all three treatment arms. The median decrease in NRS (IQR) at 60 min was -4 (2-6) in the magnesium group, -3 (2-5) in the metoclopramide group, and -4.5 (2-7) in the prochlorperazine group (p = 0.27). There were no statistically significant differences in ED length of stay, rescue analgesia, or adverse effects. Reported adverse effects were dizziness, anxiety, and akathisia. No significant difference was observed in NRS at 30 min between magnesium, metoclopramide and prochlorperazine.
Topics: Administration, Intravenous; Adult; Double-Blind Method; Female; Humans; Magnesium; Male; Metoclopramide; Middle Aged; Migraine Disorders; Patient Satisfaction; Prochlorperazine; Prospective Studies; Severity of Illness Index; Time Factors
PubMed: 33041146
DOI: 10.1016/j.ajem.2020.09.033 -
PloS One 2021Nausea and vomiting of pregnancy affects up to 80% of pregnant women, it typically occurs during the first trimester which is the most sensitive time for environmental... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nausea and vomiting of pregnancy affects up to 80% of pregnant women, it typically occurs during the first trimester which is the most sensitive time for environmental exposures given organogenesis. Metoclopramide is an antiemetic drug used widely during NVP, but the findings of studies evaluating its safety of use in pregnancy is inconsistent. Therefore, we conducted a systematic review and meta-analysis to assess whether metoclopramide use during first trimester of pregnancy is associated with the risk of major congenital malformations.
METHODS
The systematic search using database included Pubmed, Embase, Web of science, and Cochrane library. Studies written in English, comprising with an exposed group and a control group, reporting major congenital malformation as an outcome were included.
RESULTS
Six studies assessing a total number of 33374 metoclopramide-exposed and 373498 controls infants were included in this meta-analysis. No significant increase in the rate of major congenital malformation was detected following metoclopramide use during first trimester (OR, 1.14; 95% CI, 0.93-1.38).
CONCLUSIONS
Metoclopramide use during first trimester of pregnancy was not associated with the risk of major congenital malformations.
Topics: Antiemetics; Congenital Abnormalities; Female; Humans; Metoclopramide; Nausea; Odds Ratio; Pregnancy; Pregnancy Trimester, First; Vomiting
PubMed: 34543335
DOI: 10.1371/journal.pone.0257584 -
BMC Veterinary Research Aug 2017Nausea is a subjective sensation which is difficult to measure in non-verbal species. The aims of this study were to determine the efficacy of three classes of... (Comparative Study)
Comparative Study
Anti-nausea effects and pharmacokinetics of ondansetron, maropitant and metoclopramide in a low-dose cisplatin model of nausea and vomiting in the dog: a blinded crossover study.
BACKGROUND
Nausea is a subjective sensation which is difficult to measure in non-verbal species. The aims of this study were to determine the efficacy of three classes of antiemetic drugs in a novel low dose cisplatin model of nausea and vomiting and measure change in potential nausea biomarkers arginine vasopressin (AVP) and cortisol. A four period cross-over blinded study was conducted in eight healthy beagle dogs of both genders. Dogs were administered 18 mg/m cisplatin intravenously, followed 45 min later by a 15 min infusion of either placebo (saline) or antiemetic treatment with ondansetron (0.5 mg/kg; 5-HT antagonist), maropitant (1 mg/kg; NK antagonist) or metoclopramide (0.5 mg/kg; D antagonist). The number of vomits and nausea associated behaviours, scored on a visual analogue scale, were recorded every 15 min for 8 h following cisplatin administration. Plasma samples were collected to measure AVP, cortisol and antiemetic drug concentrations.
RESULTS
The placebo treated group vomited an average number of 7 times (range 2-13). None of the dogs in either the ondansetron or maropitant treated groups vomited during the observation period. The onset of nausea-like behaviour in the placebo-treated group occurred at t and peaked at t with nausea behaviour score of 58.5 ± 4.6 mm. Ondansetron and maropitant reduced overall the area under the curve of nausea behaviour score by 90% and 25%, respectively. Metoclopramide had no effect on either vomiting or nausea. Cisplatin-induced nausea and vomiting caused concomitant increases in AVP and cortisol. In the placebo-treated group, AVP and cortisol increased from t, peaked at t (11.3 ± 2.9 pmol L and 334.0 ± 46.7 nmol/L, respectively) and returned to baseline by t. AVP and cortisol increases were completely prevented by ondansetron and only partially by maropitant, while metoclopramide had no effect. The terminal half-lives (harmonic mean ± pseudo SD) for ondansetron, maropitant and metoclopramide were 1.21 ± 0.51, 5.62 ± 0.77 and 0.87 ± 0.17 h respectively.
CONCLUSIONS
5-HT receptor antagonist ondansetron demonstrates the greatest anti-emetic and anti-nausea efficacy of the three drugs. AVP and cortisol appear to be selective biomarkers of nausea rather than emesis, providing a means of objectively measuring of nausea in the dog.
Topics: Animals; Antiemetics; Arginine Vasopressin; Cisplatin; Cross-Over Studies; Dogs; Female; Hydrocortisone; Male; Metoclopramide; Nausea; Ondansetron; Quinuclidines; Vomiting
PubMed: 28814338
DOI: 10.1186/s12917-017-1156-7 -
Nutrition in Clinical Practice :... Apr 2022Metoclopramide is frequently prescribed as an adjuvant for the postpyloric placement of nasoenteric tubes (NETs). However, a recent meta-analysis showed that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Metoclopramide is frequently prescribed as an adjuvant for the postpyloric placement of nasoenteric tubes (NETs). However, a recent meta-analysis showed that metoclopramide was not beneficial in adults. Thus, this study aimed to reevaluate the effect of metoclopramide on the postpyloric placement of NETs.
METHODS
A systematic search of PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data was conducted up to August 2020 for randomized controlled trials (RCTs) comparing metoclopramide with placebo or no intervention. Trial sequential analysis (TSA) was used for the primary outcomes (the success rate of the postpyloric placement of NETs).
RESULTS
Seven eligible RCTs that included 520 participants were identified. The results of the pooled effect sizes showed that metoclopramide significantly facilitated the postpyloric placement of NETs (relative risk [RR], 1.48; 95% CI, 1.11-1.97; P = .007; I = 37%). However, the risk-of-bias assessment and the TSA results indicated that the qualities of the RCTs and the sample sizes were insufficient to confirm the efficacy of metoclopramide. Further subgroup analysis revealed that successful postpyloric placement was more pronounced in studies in which spiral NETs were employed (RR, 1.85; 95% CI, 1.41-2.43; P < .001; I = 0%). Additionally, overall adverse events were minimal.
CONCLUSIONS
The evidence accumulated so far was not strong enough to demonstrate metoclopramide's beneficial effects on the postpyloric placement of NETs. Further high-quality, large-sample RCTs are required to elucidate the effects of metoclopramide.
Topics: Adult; Critical Care; Enteral Nutrition; Humans; Intubation, Gastrointestinal; Metoclopramide; Randomized Controlled Trials as Topic
PubMed: 34155678
DOI: 10.1002/ncp.10725 -
Journal of Veterinary Internal Medicine Jul 2020Available data on the effect of gastrointestinal motility-modifying drugs in cats are limited. Most recommendations for drug usage and dosage are based on collective...
BACKGROUND
Available data on the effect of gastrointestinal motility-modifying drugs in cats are limited. Most recommendations for drug usage and dosage are based on collective clinical experience.
OBJECTIVES
To assess the effects of metoclopramide, erythromycin, and exenatide on gastric emptying (GE) and gastric motility in comparison to placebo. We hypothesized that metoclopramide and erythromycin would have prokinetic gastric effects, whereas exenatide would prolong GE times and decrease the motility index (MI) of antral contractions.
ANIMALS
Eight healthy domestic shorthair cats.
METHODS
Each cat had 4 separate ultrasonographic assessments. In a prospective, randomized, double-blind, 4-way crossover design, cats received placebo, metoclopramide, erythromycin, or exenatide for 2 days followed by a minimum 5-day washout period. Ultrasonographic GE times and MI were compared to placebo.
RESULTS
When compared to placebo, the rate of GE was significantly faster after administration of metoclopramide and erythromycin. Significant differences were found at all fractions of GE after administration of erythromycin and all but 1 fraction after metoclopramide when compared to placebo. The rate of GE in the first half of the GE curve was significantly slower after exenatide administration. The total area under the Ml curve was significantly larger after administration of metoclopramide and erythromycin than after placebo.
CONCLUSIONS AND CLINICAL IMPORTANCE
Metoclopramide and erythromycin shorten GE times and increase the MI of antral contractions, thus having a prokinetic effect in the stomach of healthy cats, whereas exenatide causes an initial delay in GE.
Topics: Animals; Cats; Cross-Over Studies; Erythromycin; Exenatide; Female; Gastric Emptying; Gastrointestinal Agents; Gastrointestinal Motility; Male; Metoclopramide; Prospective Studies; Stomach; Ultrasonography
PubMed: 32515089
DOI: 10.1111/jvim.15787 -
British Journal of Clinical Pharmacology Mar 2021The aim of this study was to evaluate the risk of trauma associated with the use of antidopaminergic antiemetics in a real-world setting.
AIMS
The aim of this study was to evaluate the risk of trauma associated with the use of antidopaminergic antiemetics in a real-world setting.
METHODS
A self-controlled case series analysis was performed using the EGB database, the representative sample of the French national healthcare insurance system database. All subjects aged 18 years and over who presented with at least 1 trauma-related hospitalization and 1 supply for domperidone, metoclopramide or metopimazine between 2009 and 2014 were included in the study. Associations were evaluated by incidence rate ratios.
RESULTS
Included exposed cases were 7610 for domperidone cohort, 2189 for metoclopramide and 3911 for metopimazine. Incidence rate ratio for trauma-related hospitalization during the first 7 days of exposure period compared to unexposed period was 1.53 (95% confidence interval 1.29-1.80) for domperidone, 2.00 (1.37-2.91) for metoclopramide and 2.30 (1.71-3.09) for metopimazine.
CONCLUSION
We found an increased risk of hospitalizations for traumatic injuries for the main marketed antidopaminergic antiemetics during the first days of use. The highest risk was observed for metopimazine, which could relate to its pharmacological profile and central effects.
Topics: Adolescent; Adult; Antiemetics; Databases, Factual; Domperidone; Hospitalization; Humans; Metoclopramide
PubMed: 32737898
DOI: 10.1111/bcp.14510 -
British Medical Journal Mar 1975
Topics: Animals; Breast Feeding; Female; Humans; Lactation; Metoclopramide; Milk; Pregnancy
PubMed: 1173219
DOI: 10.1136/bmj.1.5956.512-b