Ondansetron or metoclopramide, which is better for managing hyperemesis gravidarum?
Jordan: Ondansetron and metoclopramide seem to be equally effective for managing hyperemesis gravidarum (HG) among parturient females, says a study published in the Turkish Journal Of Obstetrics And Gynecology. However, due to the trending therapeutic efficacy and better safety profile of ondansetron, it is favored over metoclopramide.
Hyperemesis gravidarum is a pregnancy complication characterized by pernicious vomiting that affects various areas of the woman's health including electrolytes, homeostasis, and kidney function, and may have adverse fetal consequences.
Ebraheem Albazee, Faculty of Medicine, The Hashemite University, Zarqa, Jordan, and colleagues aimed to investigate the efficacy of ondansetron (intervention) versus metoclopramide (control) for treating parturient females with hyperemesis gravidarum.
For this purpose, the researchers polled data from randomized controlled trials (RCTs) using a meta-analysis approach. Five information sources were screened from inception until January 2022. Cochrane Risk of Bias (version 2) assessment tool was used for quality assessment. A total of five RCTs comprising a total of 695 patients (355 and 340 females were assigned to ondansetron and metoclopramide, respectively) were included.
Based on the meta-analysis, the researchers reported the following:
- Four RCTs had an overall "low" risk of bias, whereas one RCT had an overall "some concerns" due to a lack of sufficient information about randomization.
- There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea score [MD=0.23], length of hospital stay [MD=-0.17 days], and the number of doses of drug received [MD=0.45], and duration of intravenous fluids [MD=-1.73 hours].
This led the authors to conclude, that "there was no substantial difference in efficacy between both agents, among parturient females with HG regarding all outcomes, including PUQE score, the number of doses of drug received, length of hospital stay, and duration of intravenous fluid treatment." "Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile."
Reference:
Albazee E, Almahmoud L, Al-Rshoud F, Sallam D, Albzea W, Alenezi R, Baradwan S, Abu-Zaid A. Ondansetron versus metoclopramide for managing hyperemesis gravidarum: A systematic review and meta-analysis of randomized controlled trials. Turk J Obstet Gynecol. 2022 Jun 27;19(2):162-169. doi: 10.4274/tjod.galenos.2022.14367. PMID: 35770443.
