Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo

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Abstract

STUDY OBJECTIVE: We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department (ED) nausea and vomiting. METHODS: A prospective, randomized, double-blind, placebo-controlled trial was conducted in 2 metropolitan EDs in Melbourne, Australia. Eligible patients with ED nausea and vomiting were randomized to receive 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, or saline solution placebo. Primary outcome was mean change in visual analog scale (VAS) rating of nausea severity from enrollment to 30 minutes after study drug administration. Secondary outcomes included patient satisfaction, need for rescue antiemetic treatment, and adverse events. RESULTS: Of 270 recruited patients, 258 (95.6 ) were available for analysis. Of these patients, 87 (33.7 ) received ondansetron; 88 (34.1 ), metoclopramide; and 83 (32.2 ), placebo. Baseline characteristics between treatment groups and recruitment site were similar. Mean decrease in VAS score was 27 mm (95 confidence interval [CI] 22 to 33 mm) for ondansetron, 28 mm (95 CI 22 to 34 mm) for metoclopramide, and 23 mm (95 CI 16 to 30 mm) for placebo. Satisfaction with treatment was reported by 54.1 (95 CI 43.5 to 64.5 ), 61.6 (95 CI 51.0 to 71.4 ), and 59.5 (95 CI 48.4 to 69.9 ) for ondansetron, metoclopramide, and placebo, respectively; rescue medication was required by 34.5 (95 CI 25.0 to 45.1 ), 17.9 (95 CI 10.8 to 27.2 ), and 36.3 (95 CI 26.3 to 47.2 ), respectively. Nine minor adverse events were reported. CONCLUSION: Reductions in nausea severity for this adult ED nausea and vomiting population were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo. There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups, but differences from the placebo group did not reach significance. The majority of patients in all groups were satisfied with treatment.
Original languageEnglish
Pages (from-to)526 - 532.e1
Number of pages8
JournalAnnals of Emergency Medicine
Volume64
Issue number5
DOIs
Publication statusPublished - 2014

Cite this

@article{6b3dde7a37314d83806705dccad9e496,
title = "Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo",
abstract = "STUDY OBJECTIVE: We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department (ED) nausea and vomiting. METHODS: A prospective, randomized, double-blind, placebo-controlled trial was conducted in 2 metropolitan EDs in Melbourne, Australia. Eligible patients with ED nausea and vomiting were randomized to receive 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, or saline solution placebo. Primary outcome was mean change in visual analog scale (VAS) rating of nausea severity from enrollment to 30 minutes after study drug administration. Secondary outcomes included patient satisfaction, need for rescue antiemetic treatment, and adverse events. RESULTS: Of 270 recruited patients, 258 (95.6 ) were available for analysis. Of these patients, 87 (33.7 ) received ondansetron; 88 (34.1 ), metoclopramide; and 83 (32.2 ), placebo. Baseline characteristics between treatment groups and recruitment site were similar. Mean decrease in VAS score was 27 mm (95 confidence interval [CI] 22 to 33 mm) for ondansetron, 28 mm (95 CI 22 to 34 mm) for metoclopramide, and 23 mm (95 CI 16 to 30 mm) for placebo. Satisfaction with treatment was reported by 54.1 (95 CI 43.5 to 64.5 ), 61.6 (95 CI 51.0 to 71.4 ), and 59.5 (95 CI 48.4 to 69.9 ) for ondansetron, metoclopramide, and placebo, respectively; rescue medication was required by 34.5 (95 CI 25.0 to 45.1 ), 17.9 (95 CI 10.8 to 27.2 ), and 36.3 (95 CI 26.3 to 47.2 ), respectively. Nine minor adverse events were reported. CONCLUSION: Reductions in nausea severity for this adult ED nausea and vomiting population were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo. There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups, but differences from the placebo group did not reach significance. The majority of patients in all groups were satisfied with treatment.",
author = "Diana Egerton-Warburton and Robert Meek and Michaela Mee and George Braitberg",
year = "2014",
doi = "10.1016/j.annemergmed.2014.03.017",
language = "English",
volume = "64",
pages = "526 -- 532.e1",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Elsevier",
number = "5",

}

TY - JOUR

T1 - Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo

AU - Egerton-Warburton, Diana

AU - Meek, Robert

AU - Mee, Michaela

AU - Braitberg, George

PY - 2014

Y1 - 2014

N2 - STUDY OBJECTIVE: We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department (ED) nausea and vomiting. METHODS: A prospective, randomized, double-blind, placebo-controlled trial was conducted in 2 metropolitan EDs in Melbourne, Australia. Eligible patients with ED nausea and vomiting were randomized to receive 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, or saline solution placebo. Primary outcome was mean change in visual analog scale (VAS) rating of nausea severity from enrollment to 30 minutes after study drug administration. Secondary outcomes included patient satisfaction, need for rescue antiemetic treatment, and adverse events. RESULTS: Of 270 recruited patients, 258 (95.6 ) were available for analysis. Of these patients, 87 (33.7 ) received ondansetron; 88 (34.1 ), metoclopramide; and 83 (32.2 ), placebo. Baseline characteristics between treatment groups and recruitment site were similar. Mean decrease in VAS score was 27 mm (95 confidence interval [CI] 22 to 33 mm) for ondansetron, 28 mm (95 CI 22 to 34 mm) for metoclopramide, and 23 mm (95 CI 16 to 30 mm) for placebo. Satisfaction with treatment was reported by 54.1 (95 CI 43.5 to 64.5 ), 61.6 (95 CI 51.0 to 71.4 ), and 59.5 (95 CI 48.4 to 69.9 ) for ondansetron, metoclopramide, and placebo, respectively; rescue medication was required by 34.5 (95 CI 25.0 to 45.1 ), 17.9 (95 CI 10.8 to 27.2 ), and 36.3 (95 CI 26.3 to 47.2 ), respectively. Nine minor adverse events were reported. CONCLUSION: Reductions in nausea severity for this adult ED nausea and vomiting population were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo. There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups, but differences from the placebo group did not reach significance. The majority of patients in all groups were satisfied with treatment.

AB - STUDY OBJECTIVE: We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department (ED) nausea and vomiting. METHODS: A prospective, randomized, double-blind, placebo-controlled trial was conducted in 2 metropolitan EDs in Melbourne, Australia. Eligible patients with ED nausea and vomiting were randomized to receive 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, or saline solution placebo. Primary outcome was mean change in visual analog scale (VAS) rating of nausea severity from enrollment to 30 minutes after study drug administration. Secondary outcomes included patient satisfaction, need for rescue antiemetic treatment, and adverse events. RESULTS: Of 270 recruited patients, 258 (95.6 ) were available for analysis. Of these patients, 87 (33.7 ) received ondansetron; 88 (34.1 ), metoclopramide; and 83 (32.2 ), placebo. Baseline characteristics between treatment groups and recruitment site were similar. Mean decrease in VAS score was 27 mm (95 confidence interval [CI] 22 to 33 mm) for ondansetron, 28 mm (95 CI 22 to 34 mm) for metoclopramide, and 23 mm (95 CI 16 to 30 mm) for placebo. Satisfaction with treatment was reported by 54.1 (95 CI 43.5 to 64.5 ), 61.6 (95 CI 51.0 to 71.4 ), and 59.5 (95 CI 48.4 to 69.9 ) for ondansetron, metoclopramide, and placebo, respectively; rescue medication was required by 34.5 (95 CI 25.0 to 45.1 ), 17.9 (95 CI 10.8 to 27.2 ), and 36.3 (95 CI 26.3 to 47.2 ), respectively. Nine minor adverse events were reported. CONCLUSION: Reductions in nausea severity for this adult ED nausea and vomiting population were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo. There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups, but differences from the placebo group did not reach significance. The majority of patients in all groups were satisfied with treatment.

UR - http://www.sciencedirect.com/science/article/pii/S0196064414002236

U2 - 10.1016/j.annemergmed.2014.03.017

DO - 10.1016/j.annemergmed.2014.03.017

M3 - Article

VL - 64

SP - 526 - 532.e1

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 5

ER -