Prophylactic antiemetics fail to reduce nausea and vomiting induced by IV opioids in ED

CHICAGO: Prophylactic Metoclopramide (antiemetics) does not reduce the risk of vomiting, nausea, or the need for rescue medication when provided before intravenous opioids in an acute care setting, indicates a review results published in the Cochrane Database of Systematic Reviews

Prophylactic antiemetics may be one good option to reduce the occurrence of opioid-related adverse events in the acute care setting. Opioids, traditionally considered the most potent analgesics are often prescribed for pain in emergency rooms. However, they usually cause nausea and vomiting, in over one‐third of the patients.  also Antiemetics also cause adverse effects, so it is necessary to know their efficacy and safety before their routine use.

Michael Gottlieb, Department of Emergency Medicine, Chicago and colleagues carried out a systemic review of randomized control trials to determine the efficacy and adverse events of metoclopramide (antiemetics) on nausea and vomiting among adults receiving intravenous opioids in the acute care setting and compare it with placebo or standard care

Reviewers searched CENTRAL (The Cochrane Library), MEDLINE, Embase Google Scholar, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and screened reference lists for data and included three studies involving 527 participants (187 women and 340 men) with a mean age of 42 years. All the studies used Intravenous metoclopramide (10 mg) as the intervention and a placebo for the comparator. No studies assessed any other antiemetic or compared the intervention to standard care.

Review results showed that,

• Metoclopramide did not reduce vomiting or nausea as compared to the placebo

• There was no difference in adverse events.

• In terms of the severity of nausea, metoclopramide did not help patients any more than placebo and also didn't reduce the need for rescue medication.

The authors concluded that there is no evidence that prophylactic metoclopramide affected the risk of vomiting, nausea, or the need for rescue medication when provided before intravenous opioids in the acute care setting. There was a clinically minor difference in nausea severity between prophylactic metoclopramide and placebo. Overall, the evidence was of low certainty.

As the studies investigated only one medication (metoclopramide) and did not report all the information that reviewers anticipated, they recommend future research to delineate the effects of metoclopramide on specific populations and to evaluate the use of other prophylactic antiemetic agents, for which there were no data.

Gottlieb M, Carlson JN, Peksa GD. Prophylactic antiemetics for adults receiving intravenous opioids in the acute care setting. Cochrane Database of Systematic Reviews 2022, Issue 5. Art. No.: CD013860. DOI: 10.1002/14651858.CD013860.pub2. Accessed 26 May 2022.