Metoclopramide and Diphenhydramine

Abstract

INTRODUCTION: Metoclopramide administered with diphenhydramine has been shown to treat headaches refractory to acetaminophen in nonpregnant emergency department patients. We have shown that metoclopramide administered with diphenhydramine compared with codeine provided faster and more effective headache relief in pregnant women in whom acetaminophen was ineffective. We sought to assess the cost-effectiveness of the metoclopramide administered with diphenhydramine regimen compared with codeine in an obstetric triage unit in terms of actual cost, duration of the triage visit, and patient satisfaction. METHODS: Normotensive pregnant women in the second or third trimester at a single center were randomized to receive either metoclopramide administered with diphenhydramine intravenously (10 and 25 mg, respectively) or codeine (30 mg) orally after acetaminophen failed to relieve headache symptoms. Assessments of patient satisfaction during the 24-hour period after medication administration, duration of the triage visit, and the medication costs for each group were compared. RESULTS: Forty-four outpatients were enrolled in the study. Patients in the metoclopramide administered with diphenhydramine group reported greater satisfaction on several parameters, including relief with one dose (100% compared with 61.9%, P=.01), full headache relief (65.2% compared with 28.6%, P<.05), and likelihood to use medication again (95.7% compared with 37.1%, P<.01). Although the metoclopramide administered with diphenhydramine group incurred more medication cost than the codeine group ($1.54 compared with $0.84), both regimens were low cost. Duration of the visit was lower in the metoclopramide administered with diphenhydramine group (231 compared with 242 minutes; nonsignificant). All patients receiving metoclopramide administered with diphenhydramine had intravenous catheters compared with 33% of the codeine group. CONCLUSION: Metoclopramide administered with diphenhydramine provides more satisfying relief of headache symptoms at only a modest increase in cost.