No abstract

Domperidone is a new potent anti-emetic drug which, in contrast with metoclopramide, does not cross the blood brain barrier. The aim of the present study was to find out whether peripheral dopaminergic blockage by domperidone causes prolactin release, and if so, whether this prolactin release persists during longer-term treatment. For comparison, metoclopramide, which blocks both peripheral and central dopamine receptors, was studied using a cross-over trial design. After acute oral administration of both drugs, prolactin levels increased 10-fold. After further treatment with metoclopramide the prolactin levels were further increased to 15-fold, but after prolonged administration of domperidone a decrease to a plasma level 6-fold higher than basal was observed. The clincial implications of these findings are discussed.

SummaryIn this double-blind study the clinical efficacy of a single pre-operative intravenous dose of droperidol 1.25 mg (137 patients), granisetron 1 mg (130 patients) and granisetron 1 mg plus dexamethasone 5 mg (130 patients) was investigated for the prevention of postoperative nausea and vomiting after gynaecological surgery, breast surgery, abdominal surgery and ear, nose and throat surgery. The incidence of nausea in the first 24 h postoperatively was 52% in the droperidol group, 48% in the granisetron group and 34% with the combination, respectively. Both granisetron and granisetron/dexamethasone performed better than droperidol in their effects on vomiting or combined nausea and vomiting (incidence in the first 24 h 22%, 18% and 42%, respectively). The number of emetic episodes during the 5-day study period was significantly higher in the droperidol group (198) than in the granisetron (73) Nausea and vomiting are unpleasant consequences of general anaesthesia. The cause of postoperative nausea and vomiting (PONV) is multifactorial. Several patientrelated factors may affect the incidence of PONV, such as age, gender, weight, motion-sickness and the extent of pre-operative anxiety. Anaesthesia-related factors include the experience of the anaesthetist, premedication, anaesthetic agent (propofol), use of opioids and technique of anaesthesia. The highest incidence of PONV is found in abdominal surgery, gynaecological surgery, laparoscopic surgery, ear nose and throat surgery and breast reductions.

No abstract

Findings indicate that Dutch HDFs are rather uniform in the indications addressed and the drug groups incorporated. However, the number of individual drug entities and drug products included within groups varies considerably. Furthermore, Dutch HDFs are considered rather conservative, as older drugs are favoured over more recent drugs. Generally, with some drug exceptions, Dutch HDFs concur and comply with recommendations in national pharmacotherapeutic guidelines and with the WHO EDL over 90%.