Best metoclopramide dose for migraine? Start low, study says
Last Updated: 2011-01-28 14:10:10 -0400 (Reuters Health)
By David Douglas
NEW YORK (Reuters Health) - Metoclopramide in doses ranging from 10 to 40 mg appears to achieve similar migraine relief, New York-based researchers report in a January 12th online paper in the Annals of Emergency Medicine.
Given these results, the authors recommend 10 mg of intravenous metoclopramide as the initial dose for the treatment of acute migraine.
"Patients often present to the ED with an acute exacerbation of migraine that fails to respond to their usual therapy. It is clear that intravenous metoclopramide is an effective anti-migraine treatment, but the optimal dose of this medication is unknown," said lead author Dr. Benjamin W. Friedman in email to Reuters Health.
To gain more information, Dr. Friedman of Montefiore Medical Center in the Bronx and colleagues conducted a double-blind dose-finding study in 356 patients who required treatment of migraine without aura.
Patients randomly received 10, 20, or 40 mg of intravenous metoclopramide. They also got diphenhydramine to minimize the risk of metoclopramide-induced akathisia.
At 1 hour, the 10 mg group improved by 4.7 points on an 11-point pain rating scale. For 20 mg, the improvement was 4.9 points, and for 40 mg, it was 5.3 points.
At 48 hours, the corresponding rates of sustained freedom from pain were 16%, 20% and 21%. Drowsiness that impaired function was seen in 17% of patients overall but was distributed evenly across groups. The same was true of akathisia, which developed in 9% of patients.
"The surprising finding of our study," continued Dr. Friedman, "was that higher doses of intravenous metoclopramide are no more efficacious than standard doses."
He and his colleagues conclude that further research to assess the benefit of redosing in patients who do not achieve a satisfactory response to the initial dose may be warranted.
SOURCE:http://bit.ly/fq3AOg
Ann Emerg Med 2011.
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