Antiemetic effect of ondansetron versus metoclopramide in nauseous isolated head trauma patients: a double-blind randomized clinical trial
-
Hossein Alimohammadi
,
Hossein Partovinezhad
,
Ehsan Aliniagerdroudbari
,
Sepideh Babaniamansour
,
Effat Partovinezhad
,
Majid Shojaee
Abstract
Objective: As nausea is one of the most common annoying symptoms in isolated head trauma (IHT) and needs timely management to prevent further adverse outcomes, this study was performed to compare ondansetron and metoclopramide as therapeutic agents in nauseous IHT. Methods: This study was a double-blind clinical trial. Participants were patients visiting the ED with the chief complaint of nauseous IHT event. Group A received 10mg/2ml of metoclopramide and group B 4mg/2ml of ondansetron through slow intravenous (IV) injection. The primary outcome was the severity of nausea 20 minutes after the intervention based on the visual analogue scale (VAS) score. Results: A total of 130 patients participated in the study (65 in each group). The mean age was 30.5±20.5 years, and 73.1% of the participants were male. The decrease in the mean nausea severity scores was statistically significant in both group A (78.3±9.7 before vs. 29.8±16.8 mm after the intervention; P < 0.001) and group B (78.5±11.1 vs. 27.8±13.9 mm; P < 0.001). There was no significant difference between the mean nausea severity scores of groups A and B before the intervention (P = 0.93) or after it (P = 0.65). The decrease in the severity score of nausea was 48.5 mm in group A and 50.6 mm in group B, with no significant difference between the two groups (P = 0.63). Conclusion: Both Ondansetron and metoclopramide significantly reduced the severity of nausea in patients with mild IHT visiting ED but no treatment arm was superior. Both drugs showed good safety profiles.
1. Zamani M, Namdar B, Azizkhani R, Ahmadi O, Esmailian M. Comparing the antiemetic effects of ondansetron and metoclopramide in patients with minor head trauma. Emergency. 2015; 3(4): 137-40.
2. Farzaneh E, Fattahzadeh-Ardalani G, Abbasi V, Kahnamouei-aghdam F, Molaei B, Iziy E, et al. The epidemiology of hospital-referred head injury in Ardabil City. Emerg Med Int. 2017;2017:1439486.
3. Gerritsen H, Samim M, Peters H, Schers H, van de Laar FA. Incidence, course and risk factors of head injury: a retrospective cohort study. BMJ Open. 2018;8(5):e020364.
4. Bagheri-Hariri S, Bahreini M, Farshidmehr P, Barazandeh S, Babaniamansour S, Aliniagerdroudbari E, et al. The effect of extended-focused assessment with sonography in trauma results on clinical judgment accuracy of the physicians managing patients with blunt thoracoabdominal trauma. Arch Trauma Res. 2019;8(4):207-13.
5. Reza A, Riahi E, Daneshi A, Golchini E. The incidence of traumatic brain injury in Tehran, Iran. Brain Inj. 2018;32(4):487-92.
6. Balakrishnan B, Rus RM, Chan KH, Martin AG, Awang MS. Prevalence of postconcussion syndrome after mild traumatic brain injury in young adults from a single neurosurgical center in East Coast of Malaysia. Asian J Neurosurg. 2019;14(1):201-5.
7. Nee PA, Hadfield JM, Yates DW, Faragher EB. Significance of vomiting after head injury. J Neurol Neurosurg Psychiatry. 1999;66(4):470-3.
8. Dalhat S, Mohammad A. Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting in day-case gynaecological laparoscopic surgeries. Niger J Basic Clin Sci. 2018;15(1):24-8.
9. Abas MN, Tan PC, Azmi N, Omar SZ. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1272-9.
10. Daria U, Kumar V. Qualitative comparison of metoclopramide, ondansetron and granisetron alone and in combination with dexamethasone in the prevention of postoperative nausea and vomiting in day care laparoscopic gynaecological surgery under general anaesthesia. Asian J Pharm Clin Res. 2012;5:165-7.
11. MedicineNet. Ondansetron (Zofran) vs. metoclopramide (Reglan) [cited 2020 October 20]. Available from: https://www.medicinenet.com/ondansetron_zofran_vs_metoclopramide_reglan/article.htm.
12. Livezey MR, Briggs ED, Bolles AK, Nagy LD, Fujiwara R, Furge LL. Metoclopramide is metabolized by CYP2D6 and is a reversible inhibitor, but not inactivator, of CYP2D6. Xenobiotica. 2014;44(4):309-19.
13. Maitra S, Som A, Baidya DK, Bhattacharjee S. Comparison of ondansetron and dexamethasone for prophylaxis of postoperative nausea and vomiting in patients undergoing laparoscopic surgeries: a meta-analysis of randomized controlled trials. Anesthesiol Res Pract. 2016;2016:7089454.
14. Talebpour M, Ghiasnejad Omrani N, Imani F, Shariat Moharari R, Pourfakhr P, Khajavi MR. Comparison effect of promethazine/dexamethasone and metoclopramide /dexamethasone on postoperative nausea and vomiting after laparascopic gastric placation: a randomized clinical trial. Anesth Pain Med. 2017;7(4):e57810.
15. Khatereh I, Masoud E, Bita S, Zahra N, Yousef S. The comparative study of ondansetron and metoclopramide effects in reducing nausea and vomiting after laparoscopic cholecystectomy. Acta Med Iran. 2017;55(4):254-8.
16. Mortazavi Y, Nikbakhsh N, Alijanpour E, Rabiee O, Khalilpour A, Mortazavi S. Effect of metoclopramide and ondansetron plus dexamethason on postoperative nausea and vomiting in cholecystectomy laparoscopic surgery. J Gorgan Univ MedSci. 2014;16(1):9-13.
17. Al-Ansari K, Alomary S, Abdulateef H, Alshawagfa M, Kamal K. Metoclopramide versus ondansetron for the treatment of vomiting in children with acute gastroenteritis. J Pediatr Gastroenterol Nutr. 2011;53(2):156-60.
18. Ghaneei M, sahraei R. Comparison of ondansetron, metoclopramide, hyoscine and dexamethasone for prevention of post-operative vomiting in cataract surgery. J Jahrom Univ Med Sci. 2013;11(4):35-41.
19. Middleton PM. Practical use of the Glasgow coma scale; a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15(3):170-83.
20. Montfort. Canadian triage and acuity scale [cited 2020 October 20]. Available from: https://hopitalmontfort.com/en/canadian-triage-and-acuity-scale.
21. Patanwala A, Amini R, Hays D, Rosen P. Antiemetic therapy for nausea and vomiting in the emergency department. J Emerg Med. 2009;39:330-6.
22. Tyrdal S, Ræder J. [Re: VAS--visual analog scale]. Tidsskr Nor Laegeforen [Internet]. 2015 2015/04//; 135(7):[628 p.]. Available from: http://europepmc.org/abstract/MED/25899347
23. Egerton-Warburton D, Meek R, Mee MJ, Braitberg G. Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo. Ann Emerg Med. 2014;64(5):526-32.e1.
24. Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. Am J Emerg Med. 2006;24(2):177-82.
25. Pitts S. Neither ondansetron nor metoclopramide reduced nausea and vomiting in the emergency department. Ann Intern Med. 2014;161(12):JC3.
26. Gautam B, Shrestha BR, Lama P, Rai S. Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ). 2008;6(23):319-28.
27. Mendes MN, Monteiro RD, Martins FA. Prophylaxis of postoperative nausea and vomiting in morbidly obese patients undergoing laparoscopic gastroplasties: a comparative study among three methods. Rev bras anestesiol. 2009;59(5):570-6.
2. Farzaneh E, Fattahzadeh-Ardalani G, Abbasi V, Kahnamouei-aghdam F, Molaei B, Iziy E, et al. The epidemiology of hospital-referred head injury in Ardabil City. Emerg Med Int. 2017;2017:1439486.
3. Gerritsen H, Samim M, Peters H, Schers H, van de Laar FA. Incidence, course and risk factors of head injury: a retrospective cohort study. BMJ Open. 2018;8(5):e020364.
4. Bagheri-Hariri S, Bahreini M, Farshidmehr P, Barazandeh S, Babaniamansour S, Aliniagerdroudbari E, et al. The effect of extended-focused assessment with sonography in trauma results on clinical judgment accuracy of the physicians managing patients with blunt thoracoabdominal trauma. Arch Trauma Res. 2019;8(4):207-13.
5. Reza A, Riahi E, Daneshi A, Golchini E. The incidence of traumatic brain injury in Tehran, Iran. Brain Inj. 2018;32(4):487-92.
6. Balakrishnan B, Rus RM, Chan KH, Martin AG, Awang MS. Prevalence of postconcussion syndrome after mild traumatic brain injury in young adults from a single neurosurgical center in East Coast of Malaysia. Asian J Neurosurg. 2019;14(1):201-5.
7. Nee PA, Hadfield JM, Yates DW, Faragher EB. Significance of vomiting after head injury. J Neurol Neurosurg Psychiatry. 1999;66(4):470-3.
8. Dalhat S, Mohammad A. Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting in day-case gynaecological laparoscopic surgeries. Niger J Basic Clin Sci. 2018;15(1):24-8.
9. Abas MN, Tan PC, Azmi N, Omar SZ. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1272-9.
10. Daria U, Kumar V. Qualitative comparison of metoclopramide, ondansetron and granisetron alone and in combination with dexamethasone in the prevention of postoperative nausea and vomiting in day care laparoscopic gynaecological surgery under general anaesthesia. Asian J Pharm Clin Res. 2012;5:165-7.
11. MedicineNet. Ondansetron (Zofran) vs. metoclopramide (Reglan) [cited 2020 October 20]. Available from: https://www.medicinenet.com/ondansetron_zofran_vs_metoclopramide_reglan/article.htm.
12. Livezey MR, Briggs ED, Bolles AK, Nagy LD, Fujiwara R, Furge LL. Metoclopramide is metabolized by CYP2D6 and is a reversible inhibitor, but not inactivator, of CYP2D6. Xenobiotica. 2014;44(4):309-19.
13. Maitra S, Som A, Baidya DK, Bhattacharjee S. Comparison of ondansetron and dexamethasone for prophylaxis of postoperative nausea and vomiting in patients undergoing laparoscopic surgeries: a meta-analysis of randomized controlled trials. Anesthesiol Res Pract. 2016;2016:7089454.
14. Talebpour M, Ghiasnejad Omrani N, Imani F, Shariat Moharari R, Pourfakhr P, Khajavi MR. Comparison effect of promethazine/dexamethasone and metoclopramide /dexamethasone on postoperative nausea and vomiting after laparascopic gastric placation: a randomized clinical trial. Anesth Pain Med. 2017;7(4):e57810.
15. Khatereh I, Masoud E, Bita S, Zahra N, Yousef S. The comparative study of ondansetron and metoclopramide effects in reducing nausea and vomiting after laparoscopic cholecystectomy. Acta Med Iran. 2017;55(4):254-8.
16. Mortazavi Y, Nikbakhsh N, Alijanpour E, Rabiee O, Khalilpour A, Mortazavi S. Effect of metoclopramide and ondansetron plus dexamethason on postoperative nausea and vomiting in cholecystectomy laparoscopic surgery. J Gorgan Univ MedSci. 2014;16(1):9-13.
17. Al-Ansari K, Alomary S, Abdulateef H, Alshawagfa M, Kamal K. Metoclopramide versus ondansetron for the treatment of vomiting in children with acute gastroenteritis. J Pediatr Gastroenterol Nutr. 2011;53(2):156-60.
18. Ghaneei M, sahraei R. Comparison of ondansetron, metoclopramide, hyoscine and dexamethasone for prevention of post-operative vomiting in cataract surgery. J Jahrom Univ Med Sci. 2013;11(4):35-41.
19. Middleton PM. Practical use of the Glasgow coma scale; a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15(3):170-83.
20. Montfort. Canadian triage and acuity scale [cited 2020 October 20]. Available from: https://hopitalmontfort.com/en/canadian-triage-and-acuity-scale.
21. Patanwala A, Amini R, Hays D, Rosen P. Antiemetic therapy for nausea and vomiting in the emergency department. J Emerg Med. 2009;39:330-6.
22. Tyrdal S, Ræder J. [Re: VAS--visual analog scale]. Tidsskr Nor Laegeforen [Internet]. 2015 2015/04//; 135(7):[628 p.]. Available from: http://europepmc.org/abstract/MED/25899347
23. Egerton-Warburton D, Meek R, Mee MJ, Braitberg G. Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo. Ann Emerg Med. 2014;64(5):526-32.e1.
24. Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. Am J Emerg Med. 2006;24(2):177-82.
25. Pitts S. Neither ondansetron nor metoclopramide reduced nausea and vomiting in the emergency department. Ann Intern Med. 2014;161(12):JC3.
26. Gautam B, Shrestha BR, Lama P, Rai S. Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ). 2008;6(23):319-28.
27. Mendes MN, Monteiro RD, Martins FA. Prophylaxis of postoperative nausea and vomiting in morbidly obese patients undergoing laparoscopic gastroplasties: a comparative study among three methods. Rev bras anestesiol. 2009;59(5):570-6.
| Files | ||
| Issue | Vol 6 No 2 (2022): Spring (April) | |
| Section | Original article | |
| DOI | 10.18502/fem.v6i2.8714 | |
| Keywords | ||
| Clinical Trial Head Trauma Metoclopramide Nausea Ondansetron | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Alimohammadi H, Partovinezhad H, Aliniagerdroudbari E, Babaniamansour S, Partovinezhad E, Shojaee M. Antiemetic effect of ondansetron versus metoclopramide in nauseous isolated head trauma patients: a double-blind randomized clinical trial. Front Emerg Med. 2021;6(2):e19.
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