Intermediate dose metoclopramide is not more effective than standard dose metoclopramide for patients who present to the emergency department with nausea and vomiting: A pilot study

Abstract

Objective: To determine whether intermediate dose metoclopramide is more effective than standard dose metoclopramide for patients who present to the ED with nausea and vomiting. Methods: This prospective, single-blind, randomized trial was conducted in the ED of two community teaching hospitals in a convenience sample of adult patients who presented to ED with nausea and vomiting. Patients were randomized to receive either 10 mg metoclopramide IV or 0.4 mg/kg IV (up to a maximum dose of 32 mg). The outcomes measured were: change in nausea score (measured on a 11-point verbal rating scale), requirement for other anti-emetic drug administration, and presence of side-effects. Results: Fifty-eight patients were eligible for analysis (34 in 10 mg group and 24 in 0.4 mg/kg group). Median reduction in nausea score in 10 mg group was four (range 0-10, 95% CI 3-5) compared with five for 0.4 mg/kg group (range-1-10, 95% CI 4-6). This difference was not statistically significant (P = 0.629). Five patients in the 10 mg group required rescue anti-emetic, compared with three in the 0.4 mg/kg group (P = 1.00). There were no side-effects in the 10 mg group and two in the 0.4 mg/kg group. Conclusion: This study suggests that there is no difference in effectiveness between 10 mg and 0.4 mg/kg of metoclopramide in the ED population with nausea and vomiting.