Prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the emergency department: A randomized, double-blind clinical trial

Ernst, Amy A.; Weiss, Steven J.; Park, Sun; Takakuwa, Kevin M.; Diercks, Deborah B.

doi:10.1067/mem.2000.108652

Cited by 73 publications

(53 citation statements)

References 14 publications

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“…18 We then elected to compare ondansetron to promethazine, as it is the most commonly used ED antiemetic 1 and because our previous results invalidated two of the other common agents. Ernst et al, 4 however, have previously found prochlorperazine to be superior to promethazine.…”

Section: Discussionmentioning

confidence: 99%

“…1 Limited research has been performed in the ED setting to determine which AA is most effective with the fewest adverse effects. Previous adult ED trials have evaluated prochlorperazine alone; 2,3 prochlorperazine versus promethazine; 4 or prochlorperazine, droperidol, metoclopramide, and placebo, 5 all with mixed results. Promethazine is the most widely used AA used in the ED; thus, we selected this agent as the standard for comparison.…”

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confidence: 99%

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Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Braude

Crandall

2008

Academic Emergency Medicine

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Objectives: The authors sought to compare ondansetron and promethazine among emergency department (ED) patients with undifferentiated nausea. The hypothesis was that ondansetron was not inferior to promethazine and that rates of adverse effects were similar.Methods: This was a randomized double-blind noninferiority clinical trial conducted in an urban academic ED. A convenience sample of nonpregnant adults with at least 40 mm of self-reported nausea measured on a 100-mm visual analog scale (VAS) were enrolled. Patients who had already received more than 1 L of intravenous fluid or an antiemetic agent were excluded. Subjects were block-randomized in groups of 10 to either 4 mg of ondansetron or 25 mg of promethazine delivered intravenously. The primary outcome was change in nausea over 30 minutes. The authors used a 15-mm margin of noninferiority. Secondary endpoints included changes in anxiety, sedation, and other adverse effects. Analyses included t-tests, tests for proportions, and 95% confidence intervals (CIs).Results: A total of 120 subjects completed the study, 60 in each arm. Baseline nausea, anxiety, and sedation scores were similar. Ondansetron and promethazine reduced nausea similarly (ondansetron )34 mm, promethazine )36 mm; difference )2 mm; 95% CI = )13 to 8 mm). The reduction in anxiety was similar (ondansetron )13 mm, promethazine )14 mm; difference )1 mm; 95% CI = )10 to 10 mm). Promethazine was associated with significantly more sedation than ondansetron (ondansetron 5 mm, promethazine 19 mm; difference 14 mm; 95% CI = 5 to 24 mm). There were no cases of akathisia in the ondansetron group and 2 cases in the promethazine group.Conclusions: Promethazine and ondansetron have similar efficacy in reducing nausea among ED patients. Change in anxiety was similar, but promethazine was associated with greater sedation.ACADEMIC EMERGENCY MEDICINE 2008; 15:209-215 ª

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Braude

Crandall

2008

Academic Emergency Medicine

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“…34 Approximately half of the registry patients had accompanied nausea and vomiting; prochlorperazine with supplemental antinausea and antiemetic properties significantly reduced recurrence of both these symptoms in the first week of treatment initiation (p<0.001). 35 It should be noted that associated symptoms were reported by a large proportion of patients. This highlights the need to improve overall vertigo management practices, giving due importance to associated symptoms being reported by large number of patients, which is important for overall patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India

Kameswaran

Pujari²,

Singh³

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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Background: The objective was to evaluate the clinicoetiological pattern and pharmacotherapy practices of new onset vertigo in India. Methods: This multicentre, prospective, registry was conducted in adult patients across 37 centres. Enrolled patients were followed at week 1, month 1 and 3 to assess clinicoetiological characteristics, prescribed pharmacotherapy, safety and effectiveness of treatment. Results: Of the 1520 patients enrolled, 1428 (93.95%) completed the study. The mean (SD) age was 50.2 (±15.37) years and 53.2% were women. Of 202 patients reporting co-morbidities, 55.4% had cardiovascular disease and 38.6% had diabetes mellitus. Peripheral causes were predominant in majority (74.3%); benign paroxysmal positional vertigo (BPPV) being the most frequent (67.58%). Migraine affected 68.9% (80/116) patients, .as the central cause. Betahistine (74.6%) and prochlorperazine (21.75%) were the top two drugs of choice irrespective of origin, preferred by all treating specialists. Both the drugs significantly prevented recurrence by week 1 (prochlorperazine: 76.6%; betahistine: 64.2%) (p<0.001) and over 3 months. A lower daily dose of betahistine (15.6±5.26 mg) was preferred. Almost half complained of nausea and vomiting; prochlorperazine significantly reduced recurrence of both within a week (p<0.001). The treatments were well-tolerated with no reported adverse drug reactions. Conclusions: The study demonstrates vestibular vertigo, BPPV to be the dominant type in Indian patients with new onset vertigo. Betahistine and prochlorperazine top the physicians’ preference list, with equal benefits in preventing recurrence. Prochlorperazine has an additional antinausea and antiemetic property, thereby may improve patient satisfaction. Prescription of a lower dose of betahistine calls for the need to sensitize physicians.

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“…Antihistamines (e.g. promethazine) may cause extrapyramidal reactions, seizures and hypotension (2) and sedation and drowsiness (3) sufficient to interfere with oral rehydration therapy (ORT). Adverse effects of dopamine receptor antagonists (e.g.…”

Section: Professor Elliott and Dr Peadon's Commentarymentioning

confidence: 99%

Commentaries on ‘Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents’

Elliott

Peadon

Bayreuther

et al. 2006

Evid.‐Based Child Health

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These are commentaries on a Cochrane review published in this issue of EBCH, first published as: Alhashimi D, Alhashimi H, Fedorowicz Z. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.:CD005506. DOI: 10.1002/14651858.CD005506.pub3.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Characteristics and Key Findings Tables articles. Copyright © 2006 John Wiley & Sons, Ltd.

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Prochlorperazine versus promethazine for uncomplicated nausea and vomiting in the emergency department: A randomized, double-blind clinical trial

Cited by 73 publications

References 14 publications

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India

Commentaries on ‘Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents’

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