Effects of prophylactic anticholinergic medications to decrease extrapyramidal side effects in patients taking acute antiemetic drugs: a systematic review and meta-analysis

D’Souza, Ryan S; Mercogliano, Christopher; Ojukwu, Elizabeth; D’Souza, Shawn; Singles, Andrew; Modi, Jaymin; Short, Alexandra; Donato, Anthony A.

doi:10.1136/emermed-2017-206944

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…The FDA issued a warning about metoclopramide's risk of causing tardive dyskinesia. The risk of suffering from tardive dyskinesia is increased in patients who remain with metoclopramide for more than twelve weeks [16] in terms of treatment there is no pharmacological treatment, well established and everything is aimed at detecting this pathology early, in order to avoid its sequelae, the use of anticholinergics has been proposed, but these in turn can worsen the symptomatology [14,17]. The classic presentation consists of 4 symptoms fever, generalized muscle stiffness, alterations of mental state and dysfunction of the autonomic nervous system that presents as hyper or hypotension, increased heart rate, diaphoresis and incontinence of sphincters [17,18].…”

Section: Mechanism Of Action Of Metoclopramidementioning

confidence: 99%

Metoclopramide Poisoning

Tarapues

2022

BJSTR

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Antiemetic drugs have been used frequently in various areas of modern medicine, however there is a tendency to underestimate their adverse effects at the neurological level or in some cases they are unknown by the doctors who prescribe this medication. Extra pyramidalism syndrome due to metoclopramide is a clinical picture that occurs in patients who use this medication as a base therapy for vomiting, nausea or gastrointestinal discomfort, although it may exist in some cases of this drug with either poor dosage or misuse for suicidal purposes, it is estimated that it occurs in 1 in 500 patients, being a fairly significant adverse effect at present, which has led to conditioning its use in different population groups such as the elderly and pediatric patients.

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Section: Mechanism Of Action Of Metoclopramidementioning

confidence: 99%

Metoclopramide Poisoning

Tarapues

2022

BJSTR

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“…They are mediated through blockade of dopamine receptors in the substantia nigra and striatum. 61 The incidence of extrapyramidal symptoms in patients treated with metoclopramide is 4-25%, while the incidence with prochlorperazine is ARTICLE Full text free online at nps.org.au/australian-prescriber 25-67% 62 increasing with higher doses. These highly variable rates reflect a wide range of antiemetic doses, varying routes of administration and different rates of administration, such as a bolus injection versus intravenous infusion.…”

Section: Extrapyramidal Symptomsmentioning

confidence: 99%

Antiemetic drugs: what to prescribe and when

Athavale

Roberts

2020

Aust Prescr

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Nausea and vomiting are common symptoms with many possible causes, including the adverse effects of drugs. If a drug is indicated, the cause guides the choice of antiemetic drug.The main antiemetic classes include antagonists of the serotonin, dopamine, histamine, muscarinic and neurokinin systems, corticosteroids and benzodiazepines. Some antiemetics appear more effective for specific indications.Serotonin and neurokinin antagonists, such as ondansetron and aprepitant, are highly effective in treating chemotherapy-induced nausea and vomiting. Metoclopramide and antihistamines are first-line options for nausea and vomiting in pregnancy.Serotonin antagonists and some dopamine antagonists, such as metoclopramide, can prolong the QT interval on the ECG. Dopamine antagonists can cause extrapyramidal adverse effects, particularly in children. GastroenteritisAcute gastroenteritis is caused by viral, bacterial or protozoal infections. Therapeutic options available for adults with vomiting secondary to gastroenteritis include dopamine antagonists such as metoclopramide or prochlorperazine and serotonin antagonists such as ondansetron. 15 Nausea and vomiting resulting from acute gastroenteritis is particularly challenging in children. Until the early 2000s, antiemetics including promethazine, metoclopramide and prochlorperazine were widely used in children, however their use is now controversial due to reports of adverse events including sedation and extrapyramidal reactions. 16 When an antiemetic drug is indicated, serotonin antagonists such as ondansetron are now recommended in guidelines, such as those published by the Royal Children's Hospital Melbourne. 17 These guidelines recommend a single weight-based dose of oral ondansetron. Children weighing 8-15 kg should receive 2 mg, children weighing 15-30 kg should receive 4 mg and children weighing more than 30 kg should receive 8 mg. Ondansetron is not recommended in children under six months of age or less than 8 kg in weight. 17 A systematic review reported that oral ondansetron reduced vomiting, hospitalisation and the need for intravenous rehydration in children with acute gastroenteritis. 18 Intravenous ondansetron or metoclopramide also reduced vomiting and hospitalisation. A single study in the review reported that rectal dimenhydrinate was effective at reducing vomiting. 18

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“…Si no se logra respuesta, debe realizarse una búsqueda de los trastornos subyacentes o considerar la distonía tardía. Después de suprimir la distonía, los anticolinérgicos orales deben continuarse durante 24-48 horas (31)(32)(33)(34).…”

Section: Distonía Agudaunclassified

Extrapiramidalismo por antieméticos

Mogollón

Díaz

2020

Rev. Med.

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Los antieméticos son usados frecuentemente por diversas áreas de la medicina, aunque existe una tendencia a subestimar sus efectos adversos neurológicos. El objetivo del presente estudio de revisión fue revisar la literatura sobre la fisiología, farmacología, factores predisponentes, clínica y manejo del extrapiramidalismo por antieméticos. Se realizó una búsqueda en la literatura de artículos de revistas científicas, libros y trabajos de grado. Se utilizaron los buscadores Medline, lilacs, PubMed, embase, Current contents y Google Scholar con las siguientes palabras claves: deshidratación, gastroenteritis, vómitos, antieméticos, distonía, dopamina, hipertermia, citocromo, metoclopramida y domperidona. Se obtuvieron 252 artículos, de los cuales 50 fueron considerados aptos para la revisión. A partir del análisis, se concluyó que el uso de antieméticos es de uso frecuente por medicina general y especialidades como anestesiología y pediatría, por lo cual un conocimiento sobre los efectos extrapiramidales permitirá un diagnóstico y manejo temprano.

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Effects of prophylactic anticholinergic medications to decrease extrapyramidal side effects in patients taking acute antiemetic drugs: a systematic review and meta-analysis

Cited by 13 publications

References 30 publications

Metoclopramide Poisoning

Metoclopramide Poisoning

Antiemetic drugs: what to prescribe and when

Extrapiramidalismo por antieméticos

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