Self-assumed Neurologic Related Condition Deviated Metoclopramide-Induced Acute Dystonic of Oculogyric Crisis in a Woman of Childbearing Age: A Case Report

A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.

Dexametasona vs Metoclopramida para la prevención de náuseas y vómitos postoperatorios. Hospital Municipal Boliviano Holandés, 2017 - 2018 / Dexametasone versus Metoclopramide for the prevention of postoperative nausea and vomiting. The "Municipal Boliviano Holandés" Hospital, 2017- 2018

El objetivo del estudio es determinar la eficacia de la Dexametasona frente a la Metoclopramida en la prevención de náuseas y vómitos posoperatorios en pacientes sometidos a procedimiento quirúrgico bajo anestesia general. Se realizó un estudio descriptivo, comparativo, observacional. Se estudiaron pacientes adultos entre 18 y 60 años de edad, los cuales se dividieron en dos grupos. Grupo A se les administro Dexametasona 8 mg IV y a otro grupo B Metoclopramida 10 mg IV, posterior a la inducción anestésica. Ambos grupos fueron comparables en cuanto a sus características según los resultados se evidencia que en el grupo A de la Dexametasona se presentó menos náuseas y vómitos postoperatorios. Después de realizar el estudio se concluye que con la dexametasona existe menos incidencia de náuseas y vómitos con la dosis administrada, por lo tanto, este medicamento es eficaz para el manejo de este tipo de pacientes a comparación de la metoclopramida.

The objective of this study is to determine the efficacy of Dexamethasone versus Metoclopramide in the prevention of postoperative nausea and vomiting in patients undergoing a surgical procedure under general anesthesia. A descriptive, comparative, observational study was carried out. Adult patients between 18 and 60 years of age were studied, who were divided into two groups. Group A received Dexamethasone 8 mg IV and another group B Metoclopramide 10 mg IV, after anesthetic induction. Both groups were comparable in terms of their characteristics. It is evidenced that in group A dexamethasone there was less postoperative nausea and vomiting. Conducting the study, it is concluded that with dexamethasone there is less incidence of nausea and vomiting with the administered dose, so it is concluded that it is effective for the management of this type of patients compared to metoclopramide.

Development and optimization of metoclopramide containing polymeric patches: impact of permeation enhancers

Abstract The study is aimed to develop a monolithic controlled matrix transdermal patches containing Metoclopramide as a model drug by solvent casting method. Eudragit L100, Polyvinylpyrrolidone K-30, and Methylcellulose were used in different ratios and Polyethylene glycol 400 added as a plasticizer. Resulting patches were evaluated for their physicochemical characters like organoleptic characters, weight variation, folding endurance, thickness, swelling index, flatness, drug content, swelling index, percentage erosion, moisture content, water vapor transmission rate and moisture uptake. Formed patches were also evaluated through Fourier transform spectroscopy (FT-IR), X-ray diffraction (XRD), Differential Scanning calorimetry (DSC) and Scanning Electron Microscopy (SEM). Results of SEM unveiled smooth surface of drug-loaded patches. In-vitro dissolution studies were conducted by using dissolution medium phosphate buffer saline pH 7.4. Effect of natural permeation enhancers was elucidated on two optimized formulations (Z4 and Z9). Different concentrations (5%-10 %) of permeation enhancers i.e. Olive oil, Castor oil and Eucalyptus oil were evaluated on Franz diffusion cell using excised abdominal rat skin. Z4-O2 (Olive oil 10%) had enhanced sustain effect and flux value (310.72) close to the desired flux value. Z4-O2 followed Higuchi release model (R2= 0.9833) with non-fickian diffusion release mechanism (n=0.612)

An attempt to enhance solubility of metoclopramide base by Solid dispersion strategy and its application on development of Transdermal device

Chemotherapy induced nausea and vomiting (CINV) is an issue, which usually occurs in cancer patient. Despite high bioavailability of oral and intravenous administration, these have some drawbacks. The oral route causes hepatic first pass metabolism and intravenous route is invasive in nature. Hence, antiemetic drug by means of transdermal route is necessary to administer in such cases. The aim of the present investigation is to develop suitable Transdermal Therapeutic System (TTS) with an objective to enhance solubility and skin permeability properties of metoclopramide base. Preformulation study begins with an approach to enhance solubility of 40 metoclopramide base by solid dispersion technique. transdermal films were prepared with 41 the solid dispersion as well as with pure drug. Phase solubility study at various temperatures reveals binding constants (Ka, 95-350 M-1 for PVP K30; 56-81 M-1 for HPßCD). Spontaneity of solubilization was justified by AL type linear profiles. The films showed satisfactory diffusion (%), permeation rate and flux after 8 h study. The transdermal patches as prepared were analyzed under FTIR, DSC and SEM. Both solubility and permeability rate in this investigation have been enhanced. So, it can be affirmed that this route would effectively enhance bioavailability

The effect of ginger and metoclopramide in the prevention of nausea and vomiting during and after surgery in cesarean section under spinal anesthesia

OBJECTIVE: Postoperative nausea and vomiting is one of the most common side effects after anesthesia in surgeries, such as cesarean section. This study aimed to investigate the effect of ginger and metoclopramide in the prevention of nausea and vomiting during and after cesarean section.METHODS: This clinical trial was conducted on 180 patients aged 18–40 years who underwent cesarean section under spinal anesthesia. The first group received 10 mg of metoclopramide via intravenous injection (metoclopramide group), and the second group received 1 g of oral ginger (ginger group) half an hour before spinal anesthesia. The frequency and severity of nausea and vomiting during surgery and at 2, 6, 12, and 24 hours postoperatively were compared in both groups. To analyze the results, the t-test, chi-square test, and Mann-Whitney test were used.RESULTS: There was no significant difference in the frequency of nausea and vomiting between the 2 groups during operation, 2 hours and 6 hours after surgery (P=0.182, 0.444 and 0.563 respectively). The severity of nausea and vomiting was also similar in the 2 groups (P=0.487 and 0.652 respectively); however, the metoclopramide group had a lower systolic blood pressure (P<0.001; df=2.176; f=18.66) and mean arterial pressure (P<0.001; df=2.176; f=6.36) than the ginger group.CONCLUSION: The results revealed that ginger reduced nausea and vomiting to the same extent as metoclopramide in patients undergoing cesarean section.TRIAL REGISTRATION: Iranian Center for Clinical Trials Identifier: IRCT201611028611N3

O uso de metoclopramida em mulheres em trabalho de parto: uma revisão sistemática com metanálise / The use of metoclopramide in women in labor: a systematic review with meta-analysis

Revisão sistemática com metanálise que buscou evidências científicas sobre o efeito do cloridrato de metoclopramida na evolução do trabalho de parto, a partir de ensaio clínico controlado randomizado e recomendações da Cochrane Collaboration. A busca atemporal e sem restrições de idioma, estruturada na estratégia PICOS-T, foi realizada em bases de dados Scopus, PubMed, EMBASE, Cochrane, CINAHL e Scielo, literatura cinzenta e referências cruzadas, com estratégias e descritores específicos. As ferramentas Rayyan e EndNote Basic foram adotadas para gerenciar as referências. O estudo foi conduzido por dois avaliadores independentes e a concordância entre eles foi medida pelo Índice Kappa. Foram identificados 2.884 artigos, mas apenas 04 eram elegíveis e a qualidade metodológica destes (risco de viés e sigilo de alocação) foi avaliada com base no Cochrane Collaboration Risk of Bias Tool. O Grades of Recommendation, Assessment, Development and Evaluation foi utilizado para avaliar qualidade das evidências e força das recomendações. O relato desta pesquisa foi baseado no Preferred Report Items for Systematic Reviews and Meta-Analyzes. Não houve conflitos de interesse e qualquer tipo de financiamento. Os estudos incluídos datam de 1982 a 1992, tem 734 parturientes, "Baixo Risco de Viés" (50%) ou "Risco de Viés Incerto" (50%) e "Sigilo de Alocação Adequado" (75%). Para Ahmed et al. (1982) a metoclopramida não é eficaz para iniciar a dilatação do colo uterino no trabalho de parto espontâneo. Para Vella et al. (1985) a metoclopramida não interfere no tempo de trabalho de parto. Para Rosemblatt et al. (1991) a metoclopramida pode atuar para coordenar as contrações do útero e melhorar a força expulsiva, reduzir o tempo e facilitar a passagem do feto. Para Rossemblatt et al. (1992) doses repetidas de metoclopramida provocam redução gradativa na duração de trabalho de parto, parto e dequitação. A metanálise com 02 estudos (92 parturientes) encontrou Mean Difference= 0.8116 e RR= 0.811 (IC 95%). O tempo médio de dilatação (horas) após uso de metoclopramida versus placebo foi 4.43 versus 2.21 para Ahmed et al., com RR= -2.22. Para Rosemlatt et al., este tempo foi 4.56 versus 8.74, com RR= 4.18. O p-valor= 0.7995 revelou que não tem diferença rejeitar ou não a hipótese nula referente ao desfecho clínico pesquisado (dilatação do colo uterino). O I2= 91,56% revelou alta heterogeneidade entre os estudos e limitada aplicabilidade de seus resultados. O Teste Q de Cochran= 11.84 mostrou que há diferença de efetividade entre os resultados, rejeitando a hipótese nula citada. O "Forest Plot" mostrou que as intensidades dos resultados individuais de cada estudo diferem entre si, o que significa ausência de efeito em relação ao desfecho clínico. Este estudo apresenta nível de evidência moderado e forte recomendação dos resultados. Não há comprovação científica de que a metoclopramida favorece a dilatação do colo uterino no trabalho de parto, portanto seu uso não é recomendado. As limitações deste estudo envolveram escassos estudos elegíveis e importantes diferenças nos resultados e medições dos estudos da amostra. Novas pesquisas experimentais devem ser realizadas. As evidências deste estudo são importantes para subsidiar a prática baseada em evidência na atenção ao parto e nascimento e melhorar os desfechos materno e neonatal

A systematic review with meta-analysis that sought scientific evidence on the effect of metoclopramide hydrochloride on the evolution of labor, from a randomized controlled clinical trial and recommendations from the Cochrane Collaboration. The timeless search and without language restrictions, based on the PICOS-T strategy, was performed in databases Scopus, PubMed, EMBASE, Cochrane, CINAHL and Scielo, gray literature and cross-references, with specific strategies and descriptors. The Rayyan and EndNote Basic tools were adopted to manage the references. The study was conducted by two independent evaluators and the agreement between them was measured by the Kappa. 2.884 articles were identified, but only 04 were eligible and their methodological quality (risk of bias and allocation secrecy) was evaluated based on the Cochrane Collaboration Risk of Bias Tool. The Grades of Recommendation, Assessment, Development and Evaluation was used to evaluate the quality of the evidence and the strength of the recommendations. The report of this research was based on the Preferred Report Items for Systematic Reviews and Meta-Analyzes. There were no conflicts of interest and any kind of financing. The included studies date from 1982 to 1992, have 734 parturients, "Low Risk of Bias" (50%) or "Uncertain Bias Risk" (50%) and "Adequate Allocation Secrecy" (75%). For Ahmed et al. (1982) metoclopramide is not effective in initiating cervical dilatation in spontaneous labor. For Vella et al. (1985) metoclopramide does not interfere with labor time. For Rosemblatt et al. (1991) metoclopramide can act to coordinate the contractions of the uterus and improve the expulsive force, reduce the time and facilitate the passage of the fetus. For Rossemblatt et al. (1992) repeated doses of metoclopramide cause a gradual reduction in the duration of labor, childbirth and placental clearence. The meta-analysis with 02 studies (92 parturients) found mean difference = 0.8116 and RR = 0811 (CI 95%). The mean time of dilation (hours) after use of metoclopramide versus placebo was 4.43 versus 2.21 for Ahmed et al., with RR =-2.22. For Rosemlatt et al., this time was 4.56 versus 8.74, with RR = 4.18. The P-value = 0.7995 revealed that it has no difference to reject or not the null hypothesis referring to the clinical outcome investigated (uterine cervix dilatation). The I2 = 91.56% showed high heterogeneity between studies and limited applicability of its results. The Cochran Q Test = 11.84 showed that there is a difference in effectiveness between the results, rejecting the null hypothesis cited. The "Forest Plot" showed that the intensities of the individual results of each study differ, which means no effect in relation to the clinical outcome. This study presents a moderate level of evidence and a strong recommendation of the results. There is no scientific evidence that metoclopramide favors uterine cervix dilation in labor, therefore its use is not recommended. The limitations of this study involved scarce eligible studies and important differences in the results and measurements of the sample studies. New experimental studies should be carried out. The evidences of this study are important to subsidize the evidence-based practice in childbirth care and birth and to improve maternal and neonatal outcomes

Farmacovigilancia activa de metoclopramida 10 mg oral en pacientes del Programa de Alivio del Dolor y Cuidados Paliativos o diabetes mellitus tipo 2 en cinco hospitales del Servicio de Salud Viña del Mar-Quillota / Extrapyramidal adverse reactions to metoclopramide: a pharmacovigilance survey

Background: In 2013 the Chilean regulatory sanitary agency issued a warning concerning dose adjustment and use restriction to avoid severe adverse effects of metoclopramide such tardive dyskinesia. Aim: To study dyskinesia type adverse effects in a population using metoclopramide. Material and Methods: A cross sectional observational study was conducted among patients pertaining to palliative care and diabetes mellitus programs and consuming 10 mg/day or more of metoclopramide. Patients were interrogated looking for extrapiramidal signs and symptoms using a questionnaire validated by two neurologists. Results: In 40% of diabetic patients with gastroparesia and 35% of palliative care patients, extrapyramidal adverse reactions to metoclopramide were suspected. Palliative Care patients suffered the largest number of adverse events. The period of use and individual doses of the drug were largely above Chilean regulatory agency recommendations in all cases. Conclusions: A significant number of patients using metoclopramide could experience extrapyramidal adverse reactions.

Seguimiento e impacto de la divulgación de cinco alertas sanitarias de medicamentos en f1Colombia / Monitoring and impact of the disclosure of five health alerts for drugs in Colombia

RESUMEN Objetivo Realizar la notificación y verificar el seguimiento de cinco alertas sanitarias de medicamentos a un grupo de prestadores de salud en Colombia. Métodos Estudio cuasi-experimental, prospectivo, antes y después, sin grupo control, mediante una intervención en médicos prescriptores de ketoconazol, metoclopramida, nimesulida, diacereina, ranelato de estroncio. Se tomó como población universo a los afiliados al régimen contributivo del Sistema de Salud Colombiano en 13 entidades promotoras de salud (EPS) de Colombia. Se identificaron los pacientes que recibían mensualmente estos medicamentos previamente a la alerta. Se realizó una intervención educativa y posteriormente se midió la proporción de cambio en la dispensación. Resultados Se realizaron en total unas 26 actividades diferentes a 500 médicos prescriptores. De un total de 4 121 954 de personas se identificaron 13 979 pacientes mensuales en 2013 que recibían alguno de los cinco medicamentos y se observó una reducción en 1 470 sujetos al mes (-10,5%) para 2014. El medicamento con el que se consiguió la mayor reducción fue ketoconazol (-31,1% de casos), seguido de ranelato de estroncio (-30,3%) y metoclopramida (-8,6%). Para nimesulida (+0,7%) y diacereina (+16,4%) no se obtuvieron resultados favorables. Conclusiones Se mantienen prescripciones potencialmente riesgosas en pacientes de Colombia. Con intervenciones basadas en farmacovigilancia posterior al reporte de alertas por agencias reguladoras sanitarias, se puede disminuir la proporción de pacientes que utilizan estos medicamentos.(AU)

ABSTRACT Objective Make the notification and monitoring compliance with five health drug alerts to a group of health care providers in Colombia. Methods Quasi-experimental, prospective, before-after study, without control group, by intervening in physician prescribers of ketoconazole, metoclopramide, nimesulide, diacerein, strontium ranelate. The affiliated population of the contributory system of the Colombian Health System was taken as the universe population sample from 13 health promoting entities (EPS) of Colombia. Patients receiving monthly these drugs prior to the alert were identified. An educational intervention was performed and then the rate of change in the dispensation was measured. Results About 26 different activities were conducted on 500 prescribers. Out of a total of 4 121 954 people, 13 979 patients were identified monthly in 2013, who received some of the five medications. Likewise, a reduction in 1,470 subjects per month (-10.5%) for 2014 was observed. The drug which achieved the greatest reduction was ketoconazole (-31.1% of cases), followed by strontium ranelate (-30.3%) and metoclopramide (-8.6%). For nimesulide (+ 0.7%) and diacerein (+ 16.4%) no favorable results were obtained. Conclusions Patients with potentially risky prescriptions remain in Colombia; educational pharmacovigilance interventions made after the report alerts given by drug regulatory agencies may decrease the proportion of patients using these drugs.(AU)

Moxibustion Plus Medication Can Relieve Refractory Nausea and Vomiting and Improve Quality of Life of Advanced Cancer Patients Undergoing Chemical Therapy / 针刺研究

OBJECTIVE: To explore the efficacy of moxibustion combined with medication in the treatment of refractory nausea and vomiting and quality of life (QOL) in advanced cancer patients. METHODS: A total of 266 advanced cancer patients with nausea and vomiting were randomly assigned to Metoclopramide group (M group, n＝70), Metoclopramide plus Haloperidol group (MH group, n＝65), moxibustion ＋ M group (n＝63), and moxibustion ＋ MH group (n＝68). Moxibustion was applied to bilateral Zusanli (ST 36), and Guanyuan (CV 4), Qihai (CV 6) for 20 min every time, twice a day for 2 weeks. The Rhodes' Index of nausea, Vomiting and Retching (INVR) was used for assessing the state of these symptoms in duration, frequency and severity (40 points), the 24-item Hamilton Depression Rating Scale (HAMD, 0－76 points) was employed to measure the patients' depression severity, and the Functional Assessment of Cancer Therapy-General (FACT-G, including physical, social/family, emotional, and functional dimensions, 27 items, 108 points) was adopted to measure the cancer patients' QOL. RESULTS: Following the treatment, the INVR and HAMD scores were significantly decreased in the M, MH, moxibusion＋M and moxibustion＋MH groups in comparison with their own pretreatment (P0.05)．. CONCLUSION: Moxibustion plus Metoclopramide and Haloperidol can relieve refractory nausea and vomiting, and better depression and QOL in advanced cancer patients, being worthy of popularization in clinical practice.

Comparison of the efficacy of a combination of high dose metoclopramide and dexamethasone, with that of haloperidol, midazolam and dexamethasone, for the prevention of postoperative nausea and vomiting in laparoscopic gynecologic surgery

BACKGROUND: This prospective randomized double-blinded study was designed to compare the efficacy of a combination of high dose metoclopramide and dexamethasone with that of haloperidol, midazolam and dexamethasone, for the prevention of postoperative nausea and vomiting (PONV) in patients scheduled for laparoscopic gynecologic surgery who are receiving fentanyl intravenous-patient controlled analgesia. METHODS: The subjects were randomly allocated to either group M (20 mg metoclopramide and 10 mg dexamethasone was administered at induction, n = 35) or group H (1 mg haloperidol, 3 mg midazolam and 10 mg dexamethasone were administered at induction, n = 35). The incidence of PONV and the severity (measured by numeric rating scale) of the patients' nausea and pain were evaluated at 6 hours, 24 hours, and 48 hours, postoperatively. RESULTS: The overall incidence of the PONV was not significantly different between the two groups during the 48 hours period (group M: 21% vs. group H: 12%). The severity of the nausea and pain were similar between the two groups. CONCLUSIONS: The prophylactic use of a combination of 1 mg haloperidol, 3 mg midazolam and 10 mg dexamethasone is as effective and inexpensive as 20 mg metoclopramide and 10 mg dexamethasone to prevent PONV.

Seven Cases of Successful Remission after Trial of Metoclopramide on Orofacial Dyskinesia of Stroke Patients: a Case Series

Orofacial dyskinesia is a condition caused by various diseases in which the tongue, lips, or jaws move involuntarily. Up to now, the exact mechanism for these degenerative changes in the brain remains unknown. Among various hypotheses, the most widely accepted hypothesis is that orofacial dyskinesia is caused by supersensitivity of the dopamine receptors. As a result, metoclopramide, a dopaminergic receptor blocking agent has been chosen as a treatment agent for our study. We used metoclopramide in seven stroke patients who displayed symptoms of orofacial dyskinesia following brain damage and observed an improvement in the symptoms from all patients. This case report represented new therapeutic methods and will aid in the treatment of orofacial dyskinesia.

Intestinal duplication revealed by posterior reversible encephalopathy syndrome / 소아과

We report a unique case of intestinal duplication detected on posterior reversible encephalopathy syndrome (PRES) in a 13-year-old girl. She was admitted to the pediatric Emergency Department because of generalized seizures. Radiological assessment revealed a large, well-defined, thick-walled cystic lesion in the mid abdomen, suggestive of duplication cyst associated to a PRES. Exploration confirmed the diagnosis of ileal duplication cyst, and the mass was resected. The postoperative course was uneventful. Both hypertension and neurological dysfunction resolved after the mass resection. A followup brain magnetic resonance imaging was performed 9 months later and showed complete resolution of the cerebellar changes. Although extrinsic compression of the retroperitoneal structures has not been reported in the literature as a complication of duplication cyst, we strongly believe that this is the most logical and plausible hypothesis that would explain the pathogenesis of PRES in our patient.

Effect of Dachengqi decoction, omeprazole and cisapride in the treatment of gastric cancer radical operation in serum gastrin and motilin / 中国生化药物杂志

Objective To evaluate the effect of Dachengqi decoction,omeprazole and cisapride in the treatment of gastric cancer radical operation in serum gastrin and motilin.Methods 88 cases of gastric cancer after radical gastrectomy from May 2013 to July 2015 in our hospital were selected and divided into control group and treatment group with each 44 cases.Patients in both groups were given routine treatment and symptomatic treatment.Control group received omeprazole Enteric-coated capsules 20mg,qd,cisapride tablets 10mg,tid,treatment group received more Dachengqi decoction 200mL,bid,respectively by intragastric injection and retention enema,two times a day,a total of 21 days of treatment.The clinical efficacy,serumgastrin,plasma gastric motility,gastric juice volume and adverse reactions were compared between the two groups.Results The total effective rate in the treatment group was significantly higher than that in control group(P<0.05); After treatment,gastric juice volume of two groups was significantly lower than before treatment,the gastric juice volume in the treatment group were significantly lower than control group(P<0.05);Compare with pre-treatment,after treatment,the serum gastrin,plasma gastric motility levels of two groups were significantly higher,and the treatment group were significantly higher than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Omeprazole,cisapride combined with Dachengqi decoction in the treatment of gastric cancer radical operation was obvious and high safety.

Analysis on the effect of metoclopramide combined with psychological intervention on nausea and vomiting after laparoscopic cholecystectomy / 中国生化药物杂志

Objective To investigate the effect of metoclopramide combined with psychological intervention on nausea and vomiting after laparoscopic cholecystectomy (LC). Methods From January 2015 to January 2017, 90 patients with nausea and vomiting after laparoscopic cholecystectomy according to the different treatment and nursing intervention mode were divided into the control group and the observation group, 45cases in each group. The control group were given granisetron and routine nursing, the observation group were received metoclopramide and psychological intervention. The experimental data was recorded and compared, the improvement of nausea and vomiting were observed. Results The clinical effect in the observation group is better than that in the control group. The improvement of nausea and vomiting, the nursing satisfaction in the observation group were better than those in the control group. The differences were statistically significant (P<0.05). Conclusion Metoclopramide combined with psychological intervention on the treatment of the patients with nausea and vomiting after laparoscopic cholecystectomy, curative effect is obvious, which can effectively improve the nausea and vomiting, nursing satisfaction is high, which is worthy of clinical application.

Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers

BACKGROUND/AIMS: Prokinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance. METHODS: Nine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumen-imaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject. RESULTS: Following administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 +/- 9.2 vs 26.7 +/- 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 +/- 0.5 vs 4.1 +/- 0.5 mm2/mmHg), suggesting no significant effect of metoclopramide on EGJ compliance. CONCLUSIONS: Metoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.

Comparative study of different gastrointestinal motility drugs on capsule endoscopy / 中国医师进修杂志

Objective To compare the effect of different gastrointestinal motility drugs on capsule endoscopy. Methods Seventy-one patients with suspected small bowel disease were randomly divided into metoclopramide group (24 patients), mosapride group(25 patients) and control group (22 group). The patients in metoclopramide group swallowed capsule endoscopy immediately after intramuscularly injecting 10 mg metoclopramide, the patients in mosapride group swallowed capsule endoscopy 15 min after taking 5 mg mosapride, and the patients in control group did not take any of the gastrointestinal motility drugs. Three groups had the same bowel preparation before checking. The finishing rate of small bowel examinations, stomach and small intestinal transit time, intestinal cleanliness and the detection rates of lesions in three groups were compared. Results The total small bowel examination finishing rate was 94.4%(67/71). The small bowel examination finishing rate in metoclopramide group, mosapride group, and control group was 95.8%(23/24), 96.0%(24/25), and 90.9% (20/22), and there was no significant difference(P>0.05). The stomach transit time in metoclopramide group, mosapride group and control group was(27.5 ± 20.7), (28.1 ± 20.9) and (52.3 ± 33.5) min. The stomach transit time in metoclopramide group and mosapride group had no significant difference (P>0.05), but it was significantly lower than that in control group (P0.05). The image class scores in metoclopramide group, mosapride group and control group was (2.5 ± 0.4), (2.7 ± 0.4) and (1.7 ± 0.3) scores.The scores in metoclopramide group and mosapride group had no significant difference (P>0.05), but they were significantly higher than that in control group (P0.05), but it was significantly higher than that in control group (P<0.05). Conclusions The use of gastrointestinal motility drugs before capsule endoscopy can improve the quality of inspection, and metoclopramide and mosapride shows no significant difference.

Effects of metoclopramide on the expression of metalloproteinases and interleukins in left colonic anastomoses. An experimental study

PURPOSE : To evaluate the effects of metoclopramide on metalloproteinases (MMP) and interleukins (IL) gene expression in colonic anastomoses in rats. METHODS : Eighty rats were divided into two groups for euthanasia on the 3rd or 7th postoperative day (POD), then into two subgroups for sepsis induction or not, and then into subgroups to receive either metoclopramide or saline solution. Left colonic anastomosis were performed and then analyzed. RESULTS : On the 3rd POD, metoclopramide was associated with increased expression of MMP-1a, MMP-13, and TNF-α. On the 7th POD, the transcripts of all MMPs, TNF-α, IL-1β, IFN-γ, and IL-10 of the treated animals became negatively modulated. In the presence of sepsis, metoclopramide did not change MMPs and decreased IL-6, IL-1β, IFN-γ and IL-10 gene expression on the 3rd POD. On the 7th POD, increased expression of all MMPs, IFN-γ and IL-10 and negative modulated TNF-α and IL-6 gene expression. CONCLUSION : Administration of metoclopramide increased metalloproteinases and interleukins gene expression on the 3rd postoperative day and negatively modulated them on the 7th POD. In the presence of abdominal sepsis, metoclopramide did not change MMPs and decreased ILs gene expression on the 3rd POD. On the 7th POD, the drug increased expression of all MMPs.

Prevention of Pain on Propofol Injection: A Comparison of Lignocaine with a Combination of Metoclopramide and Lignocaine.

Background:The major disadvantage of propofol as an induction agent is the pain during injection. Lignocaine pretreatment is the most popular method for reducing this pain but this drug alone cannot eliminate the problem. The aim of this study was to examine the analgesic effect of lignocaine/metoclopramide combination, compared with lignocaine alone, during propofol injection in an adult Nigerian population at the Lagos University Teaching Hospital (LUTH). Methods: Seventy (70) American Society of Anesthesiologists (ASA) physical status class I and II adult patients; who came in for various elective surgical procedures under intravenous general anesthesia were randomly assigned to two different groups, A or B. Group A (n=35) received a combination of Inj. Lignocaine (20 mg IV) with Inj. Metoclopramide (10mg IV)mixed with Inj. Propofol (2.0mg/kg IV) and Group B (n=35)received Inj. Lignocaine (20mg IV) alone mixed with Inj. Propofol (2.0 mg/kg IV) into a dorsal hand vein. During a ten-second pause after the first 25% of the calculated propofol dose (mixed with study drugs) was given, the patients were asked standard questions regarding pain on injection before induction of anaesthesia. Thereafter, the induction of anesthesia was continued and completed with the remainder of the calculated propofol dose and endotracheal intubation facilitated with Inj. Pancuronium (0.1mg/kg IV) in the two groups. Results: With regard to (occurrence) incidence of pain on injection, the difference between the two groups was statistically significant (P<0.05) using the Chi-square test. There was no statistical difference in Verbal Pain Response (intensity) Scores (P > 0.05) using the Chi-square test, between the groups. After completion of the study, side effects (such as arrhythmias, injection site reactions, extra pyramidal reactions) were not observed following the use of the study drugs. Conclusion: A lignocaine/metoclopramide combination is more effective than lignocaine alone for reducing pain on injection of propofol in a dorsal hand vein.

Acatisia inducida por fármacos no psicotrópicos: a propósito de un caso asociado a metoclopramida / Non-psychotropic drugs induced akathisia: a propos of a case associated with metoclopramide use

La metoclopramida es un fármaco antiemético usado en diversas áreas de la práctica médica pero uno de sus efectos adversos más frecuentes y severos es la acatisia. La acatisia es un trastorno del movimiento caracterizado por sensación de intranquilidad y malestar internos acompañados de inquietud motora. Presentamos el caso de un varón de 19 años que desarrolló acatisia aguda luego de la administración de metoclopramida por vía endovenosa. Es importante tener siempre presente en la práctica clínica la posible presentación de acatisia como efecto adverso de la metoclopramida y de otros fármacos no psicotrópicos debido a la frecuencia de su aparición y a su severidad. Realizar un diagnóstico rápido y preciso es necesario para manejar adecuadamente este efecto secundario, además de tomar medidas preventivas para evitar su aparición.

Metoclopramide is an antiemetic drug used in several areas of medical practice but one of its most frequent and severe adverse effects is akathisia. Akathisia is a movement disorder characterized by internal feeling of uneasiness and discomfort accompanied by motor restlessness. We report the case of a 19 year old male who developed acute akathisia after intravenous administration of metoclopramide. It is important in clinical practice to keep in mind the occurrence of akathisia as a posible adverse effect of metoclopramide and other non-psychotropic drugs, because of the frequency of their emergence and severity. It is essential to perform a quick and accurate diagnosis to properly manage this side effect, in addition to taking preventive measures to avoid its occurrence.

The effect of metoclopramide combined with early enteral nutritional on patients with mechanical ventilation after craniocerebral operation / 中国基层医药

Objective To observe the effect of metoclopramide combined with early enteral nutritional on patients with mechanical ventilation after craniocerebral operation.Methods A prospective randomized control study was conducted.56 patients with mechanical ventilation after craniocerebral operation were randomly divided into metoclopramide combined with early enteral nutritional group (observation group) and parenteral nutrition group (control group),28 in each group.The patients in the observation group received early enteral nutrition (24-48 h after operation),and intramuscular injection of metoclopramide (10mg Q8H) for 7 days.The patients in the control group received parenteral nutrition.The nutritional parameters,mechanical ventilation (MV) time,success rate of the ventilator weaning and the occurrence rate of pneumonia associated with ventilation (VAP) in one week,the incidence of adverse reaction were compared between the two groups.Results After 1 week therapy,the nutritioual parameters of the two groups showed no statistical significance(P ＞ 0.05);the observation group compared with the control group,3 、7days of blood glucose(P1 、P2) decreased significantly[(8.9 ± 1.6) mmol/L vs (11.4 ± 3.2) mmol/L,(8.2 ± 1.3) mmol/L vs (10.6 ± 2.1) mmol/L] (P1 =0.002,P2 =0.011),Mechanical ventilation (MV) time (P3) and the occurrence rate of VAP(P4) in one week also declined[(6.5 ±2.3)d vs (8.9 ±3.1)d,21.4％ vs 46.4％] (P3 =0.022,P4 =0.048),but within a week of success rate of the ventilator weaning improved (67.9％ vs 39.3％,P5 =0.032).Return rate (P6),gastrointestinal bleeding (P7) was significantly lower than those of the control group (17.9％ vs 42.9％,14.3％ vs 42.9％,P6 =0.042,P7 =0.038),but abdominal distention,diarrhea were no significant contrast (P ＞ 0.05).Conclusion Metoclopramide combined with early enteral nutritional may obviously improve the nutrition parameters,shorten the MV time,decrease the occurrence rate of VAP,not increase in side effects.