Post by Penny on Oct 9, 2009 1:47:19 GMT -5
www.medscape.com/viewarticle/709326
Friedman BW, Bender B, Davitt M, et al. A randomized trial of diphenhydramine as prophylaxis against metoclopramide-induced akathisia in nauseated emergency department patients. Ann Emerg Med. Mar 2009;53(3):379-385.
Metoclopramide is a commonly used medication in the emergency department for the treatment of nausea, acute migraine and gastroparesis. An adverse side effect of this medication is akathisia - a complex of signs of symptoms characterized by restlessness and agitation. Various methods have been used to prevent or treat akathisia including anticholinergics, benzodiazepines and slower delivery of medication. To date, no clear consensus on which agent should be used as prophylaxis has been reached.
This randomized, double-blinded study investigated whether co-administration of diphenhydramine along with metoclopramide would decrease the incidence of akathisia. 289 patients were enrolled from a single emergency department. Exclusion criteria included patients with extrapyramidal illnesses or movement disorders, pregnancy, and use of antiemetics, antihistamines or antipsychotics within three days of presentation. Patients were randomized to receive either 10mg or 20mg of metoclopramide IV along with 25mg of diphenhydramine IV or placebo. Development of akathisia was evaluated by a Short Akathisia Instrument (SAI), a version of the Prince Henry Hospital Rating Scale of Akathisia modified for use in the ED setting. Akathisia was present if SAI scores were increased at either assessment at 30 minutes or 60 minutes or if rescue medications such as benzodiazepine were given by the primary physician.
34 patients developed akathisia and the incidence did not vary significantly among the different arms of the study. There was a trend towards akathisia in those patients who received 20mg vs. 10 mg of metoclopramide (OR 1.7) but this was not statistically significant (CI 0.8 -3.6). Only 3 of the 14 patients who developed akathisia and were not treated with rescue medications still had symptoms at 60 minutes.
Akathisia can be an adverse effect of metoclopramide administration and is often not evaluated for in the emergency department. This study showed that administration of diphenhydramine did not decrease the rate of akathisia and is not recommended for prophylactic use in this setting.
Friedman BW, Bender B, Davitt M, et al. A randomized trial of diphenhydramine as prophylaxis against metoclopramide-induced akathisia in nauseated emergency department patients. Ann Emerg Med. Mar 2009;53(3):379-385.
Metoclopramide is a commonly used medication in the emergency department for the treatment of nausea, acute migraine and gastroparesis. An adverse side effect of this medication is akathisia - a complex of signs of symptoms characterized by restlessness and agitation. Various methods have been used to prevent or treat akathisia including anticholinergics, benzodiazepines and slower delivery of medication. To date, no clear consensus on which agent should be used as prophylaxis has been reached.
This randomized, double-blinded study investigated whether co-administration of diphenhydramine along with metoclopramide would decrease the incidence of akathisia. 289 patients were enrolled from a single emergency department. Exclusion criteria included patients with extrapyramidal illnesses or movement disorders, pregnancy, and use of antiemetics, antihistamines or antipsychotics within three days of presentation. Patients were randomized to receive either 10mg or 20mg of metoclopramide IV along with 25mg of diphenhydramine IV or placebo. Development of akathisia was evaluated by a Short Akathisia Instrument (SAI), a version of the Prince Henry Hospital Rating Scale of Akathisia modified for use in the ED setting. Akathisia was present if SAI scores were increased at either assessment at 30 minutes or 60 minutes or if rescue medications such as benzodiazepine were given by the primary physician.
34 patients developed akathisia and the incidence did not vary significantly among the different arms of the study. There was a trend towards akathisia in those patients who received 20mg vs. 10 mg of metoclopramide (OR 1.7) but this was not statistically significant (CI 0.8 -3.6). Only 3 of the 14 patients who developed akathisia and were not treated with rescue medications still had symptoms at 60 minutes.
Akathisia can be an adverse effect of metoclopramide administration and is often not evaluated for in the emergency department. This study showed that administration of diphenhydramine did not decrease the rate of akathisia and is not recommended for prophylactic use in this setting.