Comparison of the effectiveness of ondansetron versus metoclopramide in hyperemesis gravidarum: a randomized clinical trial

Abstract

Objective: Nausea and vomiting are the most common complications and the first cause of hospitalization of pregnant women in the first trimester of pregnancy. Given the maternal and fetal complications as well as the negative psychosocial and economic effects of nausea and vomiting, the present study aimed to compare the antiemetic effects of ondansetron and metoclopramide. Methods: The present double-blind randomized clinical trial study was conducted on 153 pregnant women with a complaint of nausea and vomiting during pregnancy referred to the obstetrics and gynecology ward. Patients were randomly divided into two metoclopramide and ondansetron groups. The outcomes of interest were nausea and vomiting, the number of used doses of the drug, and the length of hospital stay. The Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire was used to assess the severity of nausea and vomiting. Results: The mean age was significantly higher in the metoclopramide group (28.44±6.45 vs. 25.43±5.42 years, P=0.004). On day 3, the PUQE score was significantly higher in the ondansetron group (6.60±1.10 vs. 6.56±0.88, P<0.001). The decrease in the severity of nausea and vomiting was significantly higher in the ondansetron group (5.29±1.35 vs. 4.90±1.17, P=0.05) in the second day compared to the first day. In the repeated measure analysis, significant differences were found between the two treatment groups (F=7.01, P=0.009). There was no significant difference between the two groups in terms of the length of hospital stay (P>0.05). Conclusion: In this study, ondansetron revealed more efficacy than metoclopramide on the nausea and vomiting of pregnancy (NVP) management. Ondansetron may, therefore, be considered as a safe and effective alternative for metoclopramide in the treatment of NVP.

1. Chortatos A, Haugen M, Iversen P, Vikanes Å, Magnus P, Veierød M. Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian mother and child cohort study. BJOG. 2013;120(13):1642-53.
2. Linseth G, Vari P. Nausea and vomiting in late pregnancy. Health Care Women Int. 2005;26(5):372-86.
3. Verberg M, Gillott D, Al-Fardan N, Grudzinskas J. Hyperemesis gravidarum, a literature review. Hum Reprod Update. 2005;11(5):527-39.
4. Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Nausea and vomiting of pregnancy: what about quality of life? BJOG. 2008;115(12):1484-93.
5. Chan RL, Olshan AF, Savitz DA, Herring AH, Daniels JL, Peterson HB, et al. Maternal influences on nausea and vomiting in early pregnancy. Matern Child Health J. 2011; 15(1):122–7.
6. Smith C, Crowther C, Beilby J, Dandeaux J. The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol. 2000;40(4):397-401.
7. Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt). 2009;18(12):1981-7.
8. Atanackovic G, Navioz Y, Moretti M, Koren G. The safety of higher than standard dose of doxylamine-pyridoxine (Diclectin®) for nausea and vomiting of pregnancy. J Clin Pharmacol. 2001;41(8):842-5.
9. Alimohammadi H, Partovinezhad H, Aliniagerdroudbari E, Babaniamansour S, Partovinezhad E, Shojaee M. A comparison of the antiemetic effect of ondansetron and metoclopramide in patients with nauseous isolated head trauma: adouble-blind randomized clinical trial. Front Emerg Med. 2021;In press.
10. Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynaecol. 1996;174(5):1565-8.
11. Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med. 2013;368(9):814-23.
12. Chhetry M, Thakur A, Basnet P, Joshi R, Sangraula H, Majhi S, et al. Effectiveness of ondansetron versus metoclopramide in hyperemesis gravidarum. Nepal J Obstet Gynaecol. 2014;9(2):27-32.
13. Birkeland E, Stokke G, Tangvik RJ, Torkildsen EA, Boateng J, Wollen AL, et al. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PloS one. 2015;10(4):e0119962.
14. Nikibakhsh A, Neisani samani L, Keshavarz M, Hoseini F. Incidence and severity of nausea and vomiting during pregnancy and its association with anxiety and depression in pregnant women. Iran J Nurs. 2016;29(101):1-11.
15. 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.
16. Ghahiri AA, Abdi F, Mastoo R, Ghasemi M. The effect of ondansetron and metoclopramide in nausea and vomiting of pregnancy. J Isfahan Med Sch. 2011;29(131):259-65.
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IssueVol 6 No 1 (2022): Winter (February) QRcode
SectionOriginal article
DOI 10.18502/fem.v6i1.7677
Keywords
Metoclopramide Nausea Ondansetron Pregnancy Vomiting

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How to Cite
1.
Moradiha F, Farahmandrad S, Gholami H. Comparison of the effectiveness of ondansetron versus metoclopramide in hyperemesis gravidarum: a randomized clinical trial. Front Emerg Med. 2021;6(1):e5.

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