Metoclopramide vs Prochlorperazine for the treatment of Nausea and Vomiting in the Emergency Care Setting: A Scoping Review

Master Thesis

2019

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Introduction: Nausea and vomiting are a common complaint with a wide variety of aetiologies. Patients frequently present to emergency care providers seeking treatment for nausea and vomiting. Metoclopramide and prochlorperazine are well established drugs that have long been used in the treatment of nausea and vomiting. This scoping review aims to map out the available literature on metoclopramide and prochlorperazine in treating nausea and vomiting in the emergency setting, and more specifically for prehospital use. Methods: A broad literature search was conducted using the following search terms “nausea”, “vomiting”, “emergency care setting”, “prehospital”, “motion sickness”, “emergency medical services”, “metoclopramide”, “prochlorperazine”, was done on online databases such as Pubmed, Medline, Embase Cochrane databases, CINAHL, Web of Science, TRIP and EBSCO host. Results: A total of 11 articles were found published between 1989 and 2014. Ten studies were found from emergency centres and just one from the prehospital setting. Six studies originated in America, three in Australia, one in the United Kingdom, and one in New Zealand. The total number of patients in the 11 included studies were 1319 subjects, where 511 received metoclopramide, 448 received a placebo, and 98 patients received prochlorperazine. One study found prochlorperazine to be the better antiemetic at treating nausea and vomiting, one study found metoclopramide to be better, and three studies found that the prophylactic use of metoclopramide cannot be justified. Conclusion: There is no consensus on the superiority of metoclopramide or prochlorperazine to treat uncomplicated nausea and vomiting in the emergency care setting. There is a paucity of research available and further studies needs to be done, particularly in the prehospital arena.
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