Mirtazapine (Remeron™) as Treatment for Non-Mechanical Vomiting after Gastric Bypass

Teixeira, Fábio Vieira; Novaretti, Tânia M S; Pilon, Benedito; Pereira, Paulo Cesar de Souza; Breda, Maria Fernanda C L

doi:10.1381/0960892053923923

Cited by 23 publications

(14 citation statements)

References 5 publications

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“…As it blocks receptors associated with nausea and vomiting, mirtazapine had been shown to treat severe vomiting during pregnancy [8] and to treat cancer patients with pain, nausea and a variety of distressing symptoms [9,10]. Its anti-emetic effect has also been reported after laparoscopy surgery [11] and gastric bypass [12]. Its effect on the prevention of intrathecal morphine-induced PONV has not yet undergone evaluation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Chang

Sheen

2010

Anaesthesia

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SummaryNausea and vomiting are frequent complications of intrathecal morphine. In this randomised, double-blind trial, we tested the efficacy of mirtazapine, an antidepressant that blocks receptors associated with vomiting, on the incidence of nausea and vomiting after intrathecal morphine. One hundred patients receiving spinal anaesthesia for lower limb surgery were assigned equally to take either an orally disintegrating form of 30 mg mirtazapine or matching placebo 1 h before surgery. Spinal anaesthesia was performed by injection of 15 mg isobaric bupivacaine 0.5% along with 0.2 mg preservative-free morphine. Nausea and vomiting were evaluated 3, 6, 12, 18 and 24 h after intrathecal morphine administration. The incidence of nausea and vomiting was significantly lower in patients receiving mirtazapine compared with placebo (26.5% vs 56.3%, respectively; p = 0.005). The mean (SD) onset time of postoperative nausea and vomiting was significantly delayed in mirtazapine patients: 9.4 (2.5) vs 5.2 (1.8) h, respectively; p < 0.0001. The severity of nausea and vomiting was also decreased after mirtazapine at the 3-6 h and 6-12 h periods. Our data indicate that pre-operative mirtazapine decreases the incidence, delays the onset and reduces the severity of nausea and vomiting induced by intrathecal morphine in patients undergoing spinal anaesthesia. A single dose of intrathecal morphine is often administered to patients undergoing major orthopaedic procedures to provide sustained postoperative analgesia. Postoperative nausea and vomiting (PONV) occurs frequently, with a reported incidence of up to 74% and lasting up to 24 h [1]. Serotonin (5-HT 3 ) receptor antagonists have been used as anti-emetics to prevent or to treat nausea and vomiting induced by intrathecal morphine [2][3][4][5][6]. Mirtazapine is a new antidepressant that selectively blocks postsynaptic 5-HT 2 and 5-HT 3 receptors [7]. As it blocks receptors associated with nausea and vomiting, mirtazapine had been shown to treat severe vomiting during pregnancy [8] and to treat cancer patients with pain, nausea and a variety of distressing symptoms [9,10]. Its anti-emetic effect has also been reported after laparoscopy surgery [11] and gastric bypass [12]. Its effect on the prevention of intrathecal morphine-induced PONV has not yet undergone evaluation. We therefore hypothesised that prophylactic mirtazapine would reduce the incidence and delay the onset of intrathecal morphine-induced PONV in patients undergoing orthopaedic surgery. MethodsThe protocol was approved by the Clinical Research Ethics

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Section: Discussionmentioning

confidence: 99%

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Chang

Sheen

2010

Anaesthesia

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“…However, approximately 1-5 % of patients present with difficult to control persistent N/V despite the absence of mechanical abnormalities [2]. We found that symptomatic patients have significantly higher basal, but not post-prandial, GLP-1 levels, suggesting that nonmechanical chronic N/V symptoms after RYGB surgery Fig.…”

Section: Discussionmentioning

confidence: 62%

Chronic elevation of systemic glucagon-like peptide-1 following surgical weight loss: Association with nausea and vomiting and effects on adipokines

Mohamed‐Ali

2013

Qatar Foundation Annual Research Forum Volume 2013 Issue 1

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We determined whether persistent nausea and vomiting (N/V) symptoms following Roux-en-Y gastric bypass surgery is due to elevated systemic glucagon-like peptide-1 (GLP-1) and leptin in female non-diabetic subjects. Subjects with N/V post-Roux-en-Y gastric bypass (RYGB) surgery had significantly elevated fasting GLP-1 levels compared to that with post-operative asymptomatic subjects and to morbidly obese, obese and lean subjects not undergoing surgery. Weight loss, glycaemia, insulin and post-prandial GLP-1 levels were similar in all postoperative subjects. Despite comparable BMI, leptin was significantly lower in symptomatic subjects. Furthermore, leptin secretion from subcutaneous adipose tissue was inhibited by GLP-1 (0.1-1.0 nM; n=6). Persistent N/V following RYGB surgery is associated with elevated fasting GLP-1, but lower leptin levels. The latter may be a consequence of the direct GLP-1 inhibition of leptin secretion from adipose tissue.

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“…A primeira descrição do uso da mirtazapina como droga antiemética foi realizada em 1997 em pacientes utilizando inibidores da recaptação da serotonina 9 . Posteriormente, foi usada como droga antiemética em outras situações: na quimioterapia, no pós-operatório e na hiperemese gravídica 4,15 .…”

Section: Discussionunclassified

“…Um estudo demonstrou bons resultados em dois pacientes submetidos a derivação gástrica em Y de Roux tratados com 30 mg por dia durante dois e oito meses respectivamente 15 . Apresentavam quadro importante de náusea e vômito e foram excluídas causas mecânicas através de estudo radiológico contrastado e endoscopia.…”

Section: Discussionunclassified

Uso da mirtazapina no tratamento da náusea e vômito refratários a terapia habitual após derivação gástrica em Y de Roux

Freitas

Coelho

2008

ABCD, arq. bras. cir. dig.

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Intractable nausea and vomiting following Roux-en-Y gastric bypass controlled with mirtazapineAlexandre Coutinho Teixeira de fREITAS, Júlio Cezar Uili COELHO InTRODUÇÃOA derivação gástrica em Y de Roux é bastante efetiva no tratamento da obesidade mórbida. No entanto, complicações ocorrem em até 30% dos casos . A ocorrência de náusea e vômito no pós-operatório pode causar importante déficit nutricional e normalmente está relacionada à complicações mecânicas.Esse estudo tem como objetivo descrever o caso de um paciente no pós-operatório de derivação gástrica em Y de Roux que apresentou náusea e vômito intensos de causa não mecânica, intratável com os antieméticos habituais, e que apresentou boa resposta com mirtazapina. RELATO DO CASOHomem, 24 anos, portador de obesidade mórbida refratária ao tratamento clínico, com índice de massa corporal de 46,1 Kg/m , peso de 135 kg e altura de 171 ABCDDV/588Freitas ACT, Coelho JCU. Uso da mirtazapina no tratamento da náusea e vômito refratários a terapia habitual após derivação gástrica em Y de Roux.ABCD Arq Bras Cir Dig 2008;21(1):41-3 RESUMO -Racional -A cirurgia bariátrica é procedimento com significativa morbidade. A náusea a vômito geralmente ocorrem devido à presença de complicações mecânicas como as estenoses das anastomoses. Alguns casos apresentam sintomas importantes na ausência dessas complicações. Objetivo -Relato do uso da mirtazapina no pós-operatório de cirurgia bariátrica em um paciente com náuseas de vômitos refratários ao tratamento clínico habitual, na ausência de complicações mecânicas. Relato do caso -Paciente portador de obesidade mórbida foi submetido à derivação gástrica em Y de Roux laparoscópica. Evoluiu com náusea persistente associada a episódios de vômitos refratários a ondansetron, metoclopramida e bromoprida. Não foram identificadas causas mecânicas para o quadro. Foi iniciado mirtazapina (Remeron ® ) via oral na dose de 30mg por dia durante 60 dias. Após dois dias do início da medicação foi observado melhora total do quadro. A mirtazapina é um antidepressivo que apresenta efeito antiemético através do bloqueio de receptores para a serotonina (5-HT3) no centro do vômito no tronco cerebral. Conclusão -A mirtazapina pode ser útil nos casos de náusea e vômito refratários à terapia antiemética habitual no pós-operatório de derivação gástrica em Y de Roux, quando causas mecânicas são excluídas.

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Mirtazapine (Remeron™) as Treatment for Non-Mechanical Vomiting after Gastric Bypass

Cited by 23 publications

References 5 publications

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Chronic elevation of systemic glucagon-like peptide-1 following surgical weight loss: Association with nausea and vomiting and effects on adipokines

Uso da mirtazapina no tratamento da náusea e vômito refratários a terapia habitual após derivação gástrica em Y de Roux

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