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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.
BDS
Dr. Hiral patel (BDS) has completed BDS from Gujarat University, Baroda. She has worked in private dental steup for 8years and is currently a consulting general dentist in mumbai. She has recently completed her advanced PG diploma in clinical research and pharmacovigilance. She is passionate about writing and loves to read, analyses and write informative medical content for readers. She can be contacted at editorial@medicaldialogues.in.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751