Intravenous chlorpromazine in the Emergency Department treatment of migraines: a randomized controlled trial

Bigal, Marcelo E.; Bordini, Carlos Alberto; Speciali, José Geraldo

doi:10.1016/s0736-4679(02)00502-4

Cited by 99 publications

(84 citation statements)

References 22 publications

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“…Chlorpromazine, [21] droperidol, [22] prochlorperazine, [23] and metoclopramide [24] have shown anti-migraine effi cacy and are relatively inexpensive. Prochlorperazine intravenously is just as or more effective than intravenous metoclopramide.…”

Section: Antiemetic Dopamine Antagonistsmentioning

confidence: 99%

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Shao

Hughes

Eley

2017

World Journal of Emergency Medicine

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BACKGROUND:Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition. METHODS:This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED.RESULTS: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17 SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous (IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used. CONCLUSION:Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.

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Section: Antiemetic Dopamine Antagonistsmentioning

confidence: 99%

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

Shao

Hughes

Eley

2017

World Journal of Emergency Medicine

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“…A combination of indomethacin, prochlorperazine and caffeine was more effective than sumatriptan (Di Monda et al, 2003 Level II). Parenteral chlorpromazine (Bigal, Bordini & Speciali, 2002 Level II) or low-dose IM droperidol were also effective (Richman et al, 2002 Level II); the latter was associated with a 13% incidence of akathisia.…”

Section: Chaptermentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…Prochlorperazine, chlorpromazine, promethazine or metoclopramide can be used for both migraine headache and associated nausea and vomiting [23][24][25]. Droperidol, a potent dopamine receptor antagonist, has recently been found effective for acute migraine treatment at a dose of 2.75 mg intramuscularly [26].…”

Section: Non-specific Drugsmentioning

confidence: 99%