Efficacy Of Metoclopramide Research Articles

Metoclopramide Pretreatment for Prevention of Pain on Propofol Injection: A Randomized Placebo-Controlled Study

Background: Propofol, the most frequently used intravenous anaesthetic, is used for induction, maintenance of anaesthesia and for sedation in patients scheduled for routine elective surgical procedure. Pain on propofol injection still remains a considerable concern for the anaesthesiologist.
 Objective: Aim of this study was to observe the efficacy of metoclopramide as pretreatment for the prevention of pain caused by the propofol injection in patients undergoing elective surgery under general anaesthesia.
 Materials and method: A total of 80 patients were taken up in the study in the age group of 20 to 50 years of either sex, ASA grade I/II, scheduled for routine elective surgical procedure under general anesthesia with endotracheal intubation and using propofol as induction agent. The patients enrolled were divided randomly into two groups of 40 patients each. Group A received 10 mg metoclopramide IV diluted in 5 ml saline. Group B received 5 ml of normal saline as placebo before propofol injection. The patients were asked to report their pain according to the scale provided to them in the form of none, mild, moderate and severe after injection of propofol.
 Results: The overall incidence and severity of pain were significantly less in Group A (metoclopramide group) than in group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 15% vs 45% and 5% vs 25% respectively (p<0.05). The incidence of score ‘0’ (no pain) was higher in Group A (80%) thanGroup B (25%) (p< 0.05).
 Conclusion: Intravenous metoclopramide is effective for relief of pain on propofol injection without any significant side effects.
 Delta Med Col J. Jul 2019 7(2): 71-75

Prokinetics for the treatment of functional dyspepsia: Bayesian network meta-analysis

BackgroundControversies persist regarding the effect of prokinetics for the treatment of functional dyspepsia (FD). This study aimed to assess the comparative efficacy of prokinetic agents for the treatment of FD.MethodsRandomized controlled trials (RCTs) of prokinetics for the treatment of FD were identified from core databases. Symptom response rates were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL.ResultsIn total, 25 RCTs, which included 4473 patients with FD who were treated with 6 different prokinetics or placebo, were identified and analyzed. Metoclopramide showed the best surface under the cumulative ranking curve (SUCRA) probability (92.5%), followed by trimebutine (74.5%) and mosapride (63.3%). However, the therapeutic efficacy of metoclopramide was not significantly different from that of trimebutine (OR:1.32, 95% credible interval: 0.27–6.06), mosapride (OR: 1.99, 95% credible interval: 0.87–4.72), or domperidone (OR: 2.04, 95% credible interval: 0.92–4.60). Metoclopramide showed better efficacy than itopride (OR: 2.79, 95% credible interval: 1.29–6.21) and acotiamide (OR: 3.07, 95% credible interval: 1.43–6.75). Domperidone (SUCRA probability 62.9%) showed better efficacy than itopride (OR: 1.37, 95% credible interval: 1.07–1.77) and acotiamide (OR: 1.51, 95% credible interval: 1.04–2.18).ConclusionsMetoclopramide, trimebutine, mosapride, and domperidone showed better efficacy for the treatment of FD than itopride or acotiamide. Considering the adverse events related to metoclopramide or domperidone, the short-term use of these agents or the alternative use of trimebutine or mosapride could be recommended for the symptomatic relief of FD.

The Effect of PAK1 Knockout on the Efficacy of Metoclopramide in a Murine Model of Postoperative Ileus

Postoperative ileus (POI) is characterized as a decrease in gastrointestinal motility following a surgical procedure. POI is one of the most common postoperative complications in the United States and presents a considerable cost in both financial terms and patient morbidity. Metoclopramide is a prokinetic agent which antagonizes dopamine receptors in the enteric nervous system (ENS) and is currently employed to treat POI. Reviews of the literature have shown metoclopramide to be ineffective in the treatment of POI. We have shown that intestinal smooth muscle is dysfunctional in animal models of POI, which may account for the lack of response to prokinetics such as metoclopramide. We have also shown that PAK negatively regulation myosin light chain phosphorylation in a POI model and PAK inhibition can improve smooth muscle contractility. Based on these data, we hypothesize that the response to metoclopramide will be improved in PAK1 knockout mice compared to wildtype mice after gut manipulation to induce POI. PAK1 homozygous knockout strains and C57BL/6 wildtype mice of both sexes were used. Mice of both genotypes were divided into four groups: 1) sham surgery and vehicle; 2) POI and vehicle; 3) sham surgery and 0.1mg/kg metoclopramide; 4) POI and 0.1mg/kg metoclopramide. Sections of whole ileum were harvested 24 hours post‐surgery and suspended in 37°C buffered Krebs solution while muscle contractility was measured. Amplitude, frequency, tone, and integral were calculated and a carbachol dose response curve was generated in the organ bath. As expected, a significant decrease in baseline integral and contraction amplitude, and agonist induced contractility was observed in the POI groups compared to the sham surgery groups. Contractility and responsiveness to carbachol improved in PAK1 knockout; however, response to metoclopramide was not significantly different between PAK1 knockout and wildtype mice. We conclude that PAK1 inhibition partially attenuates the development of POI but does not improve the response to metoclopramide.

Pharmacological therapy of gastroesophageal reflux in preterm infants.

Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.

Metoclopramide for Nausea and Vomiting Prophylaxis During and After Caesarean Delivery

Nausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (1966–2011), Cochrane Central Register of Controlled Trials, EMBASE (1947–2011), Google scholar, and CINAHL for randomized controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95% confidence interval, 95% CI)=0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95% CI)=0.38 (0.20, 0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (0–3 or 0–4 h) PON and POV [RR (95% CI)=0.47 (0.26, 0.87) and 0.45 (0.21, 0.93), respectively] and overall (0–24 or 3–24 h) PON (RR 0.69; 95% CI 0.52, 0.92) were also reduced with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice and further studies are needed to confirm those findings.

Metoclopramide

Metoclopramide

Efficacy of metoclopramide and dexamethasone for postoperative nausea and vomiting: a double-blind clinical trial

Postoperative nausea and vomiting are common complications of anaestnesia. This double-blind clinical trial assessed the incidence of nausea and vomiting after cataract surgery with intravenous anaesthesia in 100 patients randomly assigned to preinduction placebo (saline), metoclopramide (10 mg), dexamethasone (8 mg) or the 2 drugs combined. The incidence of nausea in the recovery room was 44% with placebo, 20% with metoclopramide, 16% with dexamethasone and 8% with the combination. The incidence of vomiting was 20%, 4%, 4% and 0% respectively in the 4 groups. Metoclopramide plus dexamethasone combination significantly decreased nausea and vomiting both in the recovery room and 24 hours afterwards and is recommended for high-risk groups, especially in outpatient surgeries.

Metoclopramide for the Treatment of Gastroesophageal Reflux Disease in Infants: A Systematic Review

Metoclopramide is a commonly used drug to treat gastroesophageal reflux disease in infants. Given its widespread use and growing concern about toxicity in this population, we conducted a systematic review of metoclopramide for the treatment of gastroesophageal reflux disease in infants. We performed a systematic search of PubMed and bibliographies of relevant review articles. We included cohort, case-control, and intervention studies of the efficacy, effectiveness, or toxicity of metoclopramide therapy for gastroesophageal reflux disease in infants. We excluded case reports, case series, review articles, and abstracts. Twelve articles met our inclusion criteria. Of these, 11 were prospective trials, and 5 were randomized, blinded clinical trials. Study size ranged from 6 to 77 patients. Eight studies showed patient improvement with metoclopramide in at least 1 measured outcome; 1 study showed worsening symptoms with metoclopramide. Of the 5 randomized, blinded trials, 2 showed no effect of metoclopramide on any outcome, and 2 showed a significant placebo effect. Four studies commented on adverse effects of therapy, with irritability being the most frequently reported potential adverse effect of therapy. Other reported adverse effects included dystonic reactions, drowsiness, oculogyric crisis, emesis, and apnea. Among studies, there was marked heterogeneity in the patient populations, dosing, and outcomes studied. Therefore, a meta-analysis was not performed. We both agreed on a US Preventive Service Task Force rating of "poor" for the level of evidence, leading to an "inconclusive" recommendation for the safety and efficacy of metoclopramide in infants. The current literature is insufficient to either support or oppose the use of metoclopramide for gastroesophageal reflux disease in infants. In the future, large blinded randomized clinical trials are needed to determine the efficacy and toxicity of metoclopramide in this population.

Benefits of transdermal fentanyl in patients with rheumatoid arthritis or with osteoarthritis of the knee or hip: an open-label study to assess pain control

SUMMARYObjectives: To evaluate the effectiveness and safety of transdermal fentanyl (TDF) for the treatment of pain associated with rheumatoid arthritis (RA) or osteoarthritis of the knee or hip (OA), which was not adequately controlled by non-opioid analgesics and/or weak opioids.Methods: The study design incorporated a 1-week run-in period when current analgesic medications were optimised, a 28-day treatment period and a 1-week taper-off period. Patients with RA (n = 104) and OA (n = 159) started treatment with TDF 25 µg/h. Patches were replaced every 72 h, with the option to up-titrate until adequate pain control was achieved. Metoclopramide was taken during the first treatment week and as needed thereafter.Results: 203 patients completed the treatment phase, 90 entered the taper-off phase. 25 µg/h was the most frequently used maximum dose (51%). Pain control was increased from 4% to 29% of patients during run-in. The number of patients reaching adequate pain control in the first treatment week was increased to 75%, and increased further to 88% on day 28 and to 80% at endpoint. From baseline (screening) to endpoint, there were significant reductions in pain ( p < 0.001) on the Wisconsin Brief Pain Inventory, and significant improvements in quality of life (Short-Form-36: physical p < 0.001; mental health p < 0.05). Eighty per cent of the patients (n = 134) assessed the treatment favourably; nausea and vomiting were the most common adverse events, mainly occurring at treatment initiation. Efficacy of metoclopramide appeared limited. TDF could be initiated in patients pre-treated with non-opioid analgesics or weak opioids and tapered off without major complications.Conclusions: TDF significantly improved pain control and quality of life, and was well tolerated in patients with RA or knee/hip OA who continued to experience pain on their current analgesic treatment. Treatment could be discontinued without issues. Nausea and vomiting was usually mild during treatment initiation. Patients’ well being could be further accommodated by optimising prophylactic treatment.

Prevention of Nausea and Vomiting during Spinal or Epidural Anesthesia for Cesarean Section - The Efficacy of Metoclopramide and Droperidol -

Prevention of Nausea and Vomiting during Spinal or Epidural Anesthesia for Cesarean Section - The Efficacy of Metoclopramide and Droperidol -

犬のメデトミジン誘発性嘔吐に対するメトクロプラミドの効果

犬のメデトミジン誘発性嘔吐に対するメトクロプラミドの効果

Evolution of Antiemetic Treatment in Hematologic Patients

Prevention and treatment of nausea and vomiting during chemotherapy or radiotherapy in hematologic diseases is still a serious problem, because severe and prolonged emesis may affect the final result of the therapy. Many studies have now demonstrated the efficacy of metoclopramide, if administered at high-dose and in particular together with other agents, such as steroids and/or tranquilizers.In the last few years, the recently synthesized serotonin antagonists have been tested and seem to be significantly useful in the control of these undesirable emetic side-effects.The AA. present personal case reports, showing satisfying results with routine doses of ondansetron on a small, but selected group of patients submitted to highly emetogenic chemotherapy which achieved a very favourable response in 25 of 28 patients.

Effects of metoclopramide on steers fed Kochia scoparia hay2

Kochia hay that had elicited mild toxicosis in sheep and cattle when fed for 21 d was fed to young, growing steers to evaluate the efficacy of metoclopramide for preventing kochia toxicosis. Twelve steers (271 +/- 39 kg) were given ad libitum access to Kochia hay for 38 d. Six steers were dosed orally with 15 mg of metoclopramide/kg of BW three times each week in gelatin capsules, and six steers received empty gelatin capsules. Steers were housed in individual outside pens for the first 28 d, then inside in metabolism stalls for the last 10 d. Kochia intake averaged 1.2 +/- .04 and 1.1 +/- .05% of BW throughout 38 d for kochia-fed control and kochia plus metoclopramide-dosed steers, respectively. During the last 10 d, metoclopramide had no effect (P greater than .15) on digestibility of DM, OM, NDF, ADF, or CP. However, metoclopramide reduced N retention (P less than .01; 20 vs 8 g/d). Kochia hay decreased serum prolactin and insulin concentrations (P less than .01) from 12.4 to 1.5 ng/ml and from .53 to .23 ng/ml, respectively. Metoclopramide had no effect (P greater than .50) on prolactin or insulin in steers fed kochia hay. Serum growth hormone was not affected by kochia but was suppressed by metoclopramide in steers fed kochia hay (P less than .07). Serum bilirubin (total and unconjugated) was elevated (P less than .05), indicating early, mild hepatotoxicosis characteristic of kochia toxicosis. Kochia also increased serum concentrations of iron, total protein, albumin, globulin, and creatinine and decreased urea N (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

The Antiemetic Activity of High-Dose Metoclopramide and High-Dose Alizapride in Combination with Lorazepam in Patients Receiving Cancer Chemotherapy

The antiemetic efficacy of metoclopramide and lorazepam (MTC + L) versus alizapride and lorazepam (ALZ + L) was compared in 100 patients receiving chemotherapy, in a prospective randomized double-blind study. In highly emetogenic (HE) regimen (including platinum) patients received MTC 1 mg/kg or ALZ 3 mg/kg x 4 doses, and lorazepam 2.5 mg 30 min before therapy. In moderately emetogenic (ME) regimen patients received MTC 0.5 mg/kg or ALZ 1.5 mg kg x 3 doses, and lorazepam 2.5 mg 30 min before therapy. In both HE and ME regimen groups there was no statistically significant difference between MTC + L and ALZ + L treatments as regards the number of vomiting episodes, the duration of emesis and nausea, the intensity of nausea and side effects, but a statistically significant difference between treatments was found in the HE group where MTC-L was superior to ALZ + L in obtaining complete protection from vomiting (37 vs 11%, p = 0.05). No significant difference in side effects was observed.

Antiemetic activity of high-dose methylprednisolone associated with continuous-infusion metoclopramide and oral alprazolam during multiple-day chemotherapy

The addition of high-dose methylprednisolone (120 mg given i.v. and repeated after a 4-h interval) to a conventional antiemetic regimen consisting of metoclopramide (0.5 mg/kg given as an i.v. bolus over 30 min followed by 1 mg/kg given as a continuous infusion over 24 h) and alprazolam (0.5 mg given p.o.) was evaluated in a randomized study of leukemic patients undergoing anthracycline-containing multiple-day chemotherapy. Double-blind analysis was done in 30 patients who completed a total of 40 treatment courses. Cumulative 3-day results revealed complete control of nausea in 66% of patients and complete control of emesis in 77% of cases. The addition of methylprednisolone significantly reduced the occurrence of nausea (p = 0.003) and emesis (P = 0.06). Moreover, antiemetic rescue with chlorpromazine was less frequently necessary in patients receiving corticosteroids (P = 0.02). No harmful side effect was observed, and the incidence of severe infectious episodes was similar in both arms. We conclude that high-dose methylprednisolone can improve the efficacy of metoclopramide and alprazolam in controlling nausea and emesis induced by anthracycline-containing multiple-day chemotherapy in patients with acute myeloblastic leukemia.

Dexamethasone can potentiate the anti-emetic action of a 5HT3 receptor antagonist on cyclophosphamide induced vomiting in the ferret

A new group of selective 5HT3 antagonists are proving to be effective anti-emetics for cytotoxic and radiation induced vomiting in both animal models and man. Current anti-emetic regimens often benefit from combination therapy, in particular the efficacy of metoclopramide (which can be a weak 5HT3 antagonist), can be improved by combination with dexamethasone, another anti-emetic. Hence it was of interest to evaluate whether a 5HT3 receptor antagonist GR38032F could be improved by combination with dexamethasone. Vomiting induced by cyclophosphamide in the ferret was observed after pre-treatment with dexamethasone alone or in combination with GR38032F. Animals were also observed for signs of 'nausea'. Dexamethasone alone proved a weak anti-emetic in this system but did have significant effects on 'nausea'. GR38032F has previously been shown to be capable of totally controlling emesis due to cyclophosphamide in the ferret. Here a dose of GR38032F that is not 100% effective was employed; this was shown to have effects on 'nausea' but most interestingly its anti-emetic action was increased by combination with dexamethasone. This may be important for the minority of patients whose vomiting is not completely controlled by GR38032F alone.