Antiemetics in the Emergency Department: Sure Look it!

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Many patients admitted to the emergency department (ED) suffer of nausea and vomiting – and many doctors treat this with antiemetics like metoclopramide or ondansetron. Treating nausea is tricky and of course we all try to do our best to comfort patients as good as possible. But are you really sure giving an antiemetic in the ED actually improves symptoms?

Unfortunately results coming in on this topic do not look very promising. 3 publications looked at exactly this setting and although their number of patients isn’t overwhelming the results are rather discouraging.

Egerton-Warburton and colleagues performed a RCDT and looked a total 258 patients who got either metoclopramide, ondansetron or normal saline as a treatment for nausea in the ED. They basically found no differences in reduction of nausea severity.

Back in 2006 Braude et al. already stated in a RCDT including 97 patients that metoclopramide and prochlorperazine were not more effective than saline placebo as an antiemetics in the ED. Only droperidol was found to be more effective than metoclopramide or prochlorperazine but caused more extrapyramidal symptoms.

And in 2011 Barrett and colleagues published a study with 163 patients where they compared metoclopramide, ondansetron, promethazine and saline placebo in the ED. Same again: no evidence was found that ondansetron is superior to metoclopramide and promethazine in reducing nausea in ED adults.
Even if the number of patients is not that big… it’s three trials so far and they all don’t really support the use of antiemetics in the emergency department.
It is interesting to note that these drugs have been proven to be effective in the setting of chemotherapy and in anaesthetics, but the setting in the ED seems to differ. At least most patients experienced some relief over time… most probably to treatment of the cause itself!

Egerton-Warburton et al. Ann Emerg Med. 2014;64:526-532 OPEN ACCESS

Braude, D et al. Am J Emerg Med. 2006; 24: 177–182

Barrett et al. Am J Emerg Med. 2011; 29: 247–255

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