metoclopramide for migraine

6 Feb

prochlorperazine (COMPAZINE) versus metoclopramide (REGLAN)

STUDY: 

77 study patients, randomized, double-blind, clinical trial

comparing 2 parenteral dopamine antagonists.

administered during 15 minutes with 25 mg intravenous diphenhydramine (pre-treat for dystonic reactions)

mean change in numeric pain rating scale scores at 1 hour:

  • 5.5 in subjects receiving prochlorperazine
  • 5.2 in subjects receiving metoclopramide
  • Findings were similar at 2 hours and 24 hours. 

THEIR CONCLUSION:

Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously, combined with diphenhydramine 25 mg intravenously, is an efficacious treatment for ED patients with acute migraine. Three quarters of subjects in both arms would want the same medication for their next migraine.

 

DOES DOSE MATTER? (short answer: no)

STUDY: 

randomized 356 patients to 10, 20, or 40 mg of intravenous metoclopramide.

coadministered diphenhydramine to all patients

 

At 1 hour:

  • 10 mg improved by a mean of 4.7 numeric rating scale points
  • 20 mg improved by 4.9 points
  • 40 mg improved by 5.3 points

Rates of 48-hour sustained pain freedom:

  • 10-mg: 16% (95% CI 10% to 24%)
  • 20-mg: 20% (95% CI 14% to 28%)
  • 40-mg: 21% (95% CI 15% to 29%)

THEIR CONCLUSION:

20 mg or 40 mg of metoclopramide is no better for acute migraine than 10 mg of metoclopramide.

 

References: versus study; dose study; picture

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