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Therapy. J Intraven Nurs. 1996; 19: 4658. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993; 43: 245248. Gazmararian JA, Peterson R, Jamieson DJ, et al. Obstet Gynecol. 2002; 100: 94100. Godsey RK, Newman RB. Hyperemesis gravidarum: a comparison of single and multiple admissions. J Reprod Med. 1991; 36: 287290. Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol. 1998; 41: 597605. HCUP Healthcare Cost and Utilization Project ; . 2001. Agency for Healthcare Research and Quality, Rockville, Md. Available at: : hcup.ahrq.gov HCUPnet . Accessed Sept. 29, 2004. Koren G, Bishai R, eds. Nausea and vomiting of pregnancy: state of the art, 2000. Vol. 1, The Motherisk Program: Toronto; 2000: 59. Koren G, Boskovic R, Hard M, et al. Motherisk-PUQE pregnancy-unique quantification of emesis and nausea ; scoring system for nausea and vomiting of pregnancy. J Obstet Gynecol. 2002; 186 5 ; : S228S231. Martynshin MYA, Arkhengel'skii AE. Experience in treating early toxicoses of pregnancy with metoclopramide. Akush Ginekol. 1981; 57: 4455. McCallum RW, Valenzuela G, Polepalle S, Spyker D. Subcutaneous metoclopramide in the treatment of symptomatic gastroparesis: clinical efficacy and pharmacokinetics. J Pharmacol Exp Ther. 1991; 258: 136142. Naef RW, Chauhan SP, Roach H, et al. Treatment for hyperemesis gravidarum in the home: an alternative to hospitalization. J Perinatol. 1995; 15: 289292. Peleg D, Niebyl JR. Prescribing antiemetic therapy during pregnancy. Contemp OB GYN. 1997; 42: 164171. Reglan [metoclopramide] product information, 1997. A. H. Robins Co. Tierson FD, Olsen CL, Hook EB. Nausea and vomiting of pregnancy and association with pregnancy outcome. J Obstet Gynecol. 1986; 155 5 ; : 10171022. Vellacott ID, Cooke EJA, James CE. Nausea and vomiting in early pregnancy. Int J Gynecol Obstet. 1988; 27: 5762 and reglan.
REGLAN Mtoclopramid Tablits and Hydrochiorid. ; nsctabI. Description: Reglan metocIopramde hydroch'oride ; is avaiIabe in both oral and parenteral torms Reglan Tablets are while, round, compressed tablets engraved Reglan and HR on one side and scored on the opposite side Each tablet contains Metoclppramide base 10mg asthe monohydrochioride monohydrate ; Reglan Injectable is a clear colorless, sterile solution with a pH of for intravenous and intramuscular administration Each 2 ml ampul contains Metoctopramide base as the monohydrochioride monohydrate ; Sodium Metabisultite, NF2 96mg, Sodium Water for Injection, USP p 10mg Chloride, USP 4 mg. Radiological examination Reglan Injectable may be used to stimulate gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and or small intestine Contraindication.: Metoclooramide should not be used whenever stimulation of gastrointestinal motility might be dangerous. e g . inthe presence of gastrointestinal hemorrhage. mechanical obstruction, or perforation Meticlopramide is contraindicated in patients with pheo.
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Hela Chebbi Research Monitor & Doctoral student Institute of Enterprise Administration IAE ; University of Jean Moulin, Lyon 3 France helacheb yahoo After gaining a diploma in International Trade in 2002 from ESSEC University- Tunisia, I obtained a Masters in International Management Degree IAE, Lyon 3 ; . Within the framework of this master, I studied new product development projects in the pharmaceutical industry. I continue to carry a particular interest in this field in my research. My previous professional experience includes several training positions in pharmaceutical firms. I also participated in the development and the installation of electronic procedures import export transactions for international trade in other firms. Currently, I'm a doctoral student at the Institute of Enterprise's Administration, IAE ; in Lyon, France. I'm currently preparing my thesis under the guidance of Professor Emmanuelle Reynaud. Through this research, I'm interested in studying the role of a subsidiary's knowledge in the global strategy of innovation in multinationals.
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Metoclopramide hydrochloride Tablets , metoclopramide hydrochloride 10 mg Injection Solution for injection ; , metoclopramide hydrochloride 5 mg ml, 2-ml ampoule Uses: nausea and vomiting associated with migraine; nausea and vomiting in gastrointestinal disorders and cytotoxic therapy section 17.2 ; Contraindications: gastrointestinal obstruction, haemorrhage or perforation; 34 days after gastrointestinal surgery; phaeochromocytoma Precautions.
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What are the effects? Prolonged hiccup interferes significantly with a patient's daily living. It affects eating, talking and sleeping resulting in fatigue, weight loss and depression. How is it treated? Various therapies are available for the management of chronic hiccup. Treatment will depend on the most likely cause. Gastric distension 1. Antiflatulent e.g. Kolanticon If symptoms persist 2. Add a prokinetic agent e.g. metoclopramide and nimodipine!
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| Prescription DrugsHistory of postoperative nausea and vomiting PH-PONV - ; . Absence of vomiting was used as the index of effectiveness. RESULTS: Twenty-one trials involving 3984 patients 2446 in ondansetron groups and 1538 in placebo groups; 1163 PHPONV + ; patients and 2821 PH-PONV - ; patients ; met the selection criteria. The effectiveness of the 4 mg dose of ondansetron was: OR 95% CI ; 2.40 1.77-3.26 ; vs. 2.71 2.23-3.30 ; for the patients of PH-PONV + ; and PH-PONV - ; subgroups, respectively. For the 8 mg dose, the effectiveness of ondansetron was: PH-PONV + ; 4.21 2.66-6.66 ; and PHPONV - ; 2.61 1.81-3.59 ; . For neither of the doses evaluated was there any significant statistical difference between the subgroups. CONCLUSIONS: The effectiveness of ondansetron in the prevention of postoperative vomiting is not affected by the patients' PH-PONV. Anesth Analg. 1999 Jun; 88 6 ; : 1370-9. Comment in: Anesth Analg. 1999 Dec; 89 6 ; : 1589. Anesth Analg. 1999 Jun; 88 6 ; : 1200-2. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Domino KB, Anderson EA, Polissar NL, Posner KL. Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA. kdomino u.washington Postoperative nausea and vomiting are important causes of morbidity after anesthesia and surgery. We performed a metaanalysis of published, randomized, controlled trials to determine the relative efficacy and safety of ondansetron, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting. We performed a literature search of English references using both the MEDLINE database and a manual search. Double-blinded, randomized, controlled trials comparing the efficiency of the prophylactic administration of ondansetron, droperidol, and or metoclopramide therapy during general anesthesia were included. A total of 58 studies were identified, of which 4 were excluded for methodological concerns. For each comparison of drugs, a pooled odds ratio OR ; with a 95% CI was calculated using a random effects model. Ondansetron pooled OR 0.43, 95% CI 0.31, 0.61; P 0.001 ; and droperidol pooled OR 0.68, 95% CI 0.54, 0.85; P 0.001 ; were more effective than metoclopramide in preventing vomiting. Ondansetron was more effective than droperidol in preventing vomiting in children pooled OR 0.49; P 0.004 ; , but they were equally effective in adults pooled OR 0.87; P 0.45 ; . The overall risk of adverse effects was not different among drug combinations. We conclude that ondansetron and droperidol are more effective than metoclopramide in reducing postoperative vomiting. IMPLICATIONS: We performed a systematic review of published, randomized, controlled trials to determine the relative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting. Ondansetron and droperidol were more effective than metoclopramide in reducing postoperative vomiting. The overall risk of adverse effects did not differ. Anesth Analg. 1999 Jun; 88 6 ; : 1362-9. Comment in: Anesth Analg. 1999 Jun; 88 6 ; : 1200-2. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Lee A, Done ML. Department of Anaesthetics, Liverpool Hospital, New South Wales, Australia. annal nch .au We assessed the efficacy of nonpharmacologic techniques to prevent postoperative nausea and vomiting PONV ; by systematic review. These studies included acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation, and acupressure. Of the 24 randomized trials retrieved by a search of articles indexed on the MEDLINE and EMBASE databases 1980-1997 ; , 19 were eligible for meta-analysis. The primary outcomes were the incidence of nausea, vomiting, or both 0-6 h early efficacy ; or 0-48 h late efficacy ; after surgery. The pooled relative risk RR ; and numbers needed to treat NNT ; were calculated. In children, no benefit was found. Some results in adults were significant. Nonpharmacologic techniques were similar to antiemetics in preventing early vomiting RR 0.89 [95% confidence interval 0.47-1.67]; NNT 63 [10-infinity] ; and late vomiting RR 0.80 [0.35-1.81]; NNT 25 [5-infinity] ; in adults. Nonpharmacologic techniques were better than placebo at preventing early nausea RR 0.34 [0.20-0.58]; NNT 4 [3-6] ; and early vomiting in adults RR 0.47 [0.34-0.64]; NNT 5 [4-8] ; . Nonpharmacologic techniques were similar to placebo in preventing late vomiting in adults RR 0.81 [0.46-1.42]; NNT 14 [6-infinity] ; . Using nonpharmacologic techniques, 20%-25% of adults will not have early PONV compared with placebo. It may be an alternative to receiving no treatment or first-line antiemetics. IMPLICATIONS: This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children. Anesth Analg. 1999 Jun; 88 6 ; : 1354-61. Comment in: Anesth Analg. 1999 Jun; 88 6 ; : 1200-2. Anesth Analg. 2000 Sep; 91 3 ; : 763. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy: a quantitative systematic review. Tramer MR, Walder B. Department APSIC, Geneva University Hospital, Switzerland. martin.tramer hcuge.ch Nausea and vomiting are frequent adverse effects of patient-controlled analgesia PCA ; with opioids. To identify the optimal prophylactic antiemetic intervention in this setting, we performed a systematic search for randomized trials MEDLINE, EMBASE, Cochrane library, reference lists, hand-searching, no language restriction ; published up to May 1998 that compared prophylactic antiemetic interventions with placebo or no treatment in the postoperative PCA-setting with opioids and noroxin.
ADRENOCORTICAL 99: 1081-1087 15. Missale C, Liberini P, Memo M, Carruba MO, Spano P 1986 Characterization of dopamine receptors associated with aldosterone secretion in rat adrenal glomerulosa. Endocrinology 119: 22272232 16. Edwards CRW, Al-Dujaili EAS, Boscaro M, Quyyumi S, Miall PA, Rees LH 1980 In vivo and in vitro studies on the effect of me6oclopramide on aldosterone secretion. Clin Endocrinol Oxf ; 13: 45-50 17. Lauer CG, Braley LM, Menachery AI, Williams GH 1982 M4toclopramide inhibits aldosterone biosynthesis in vitro. Endocrinology 111: 238-243 18. Jarry H, Duker E, Wuttke W 1985 Adrenal release of catecholamines and met-enkephalin before and after stress as measured by a novel in vivo dialysis method in the rat. Neurosci Lett 60: 273278 19. Jarry H, Dietrich M, Duker E, Wuttke W 1987 Effect of systemic and local administration of etomidate on adrenocortical steroidogenesis in male rats. Acta Endocrinol Copenh ; 114: 402-409 20. Jarry H, Dietrich M, Barthel A, Giesler A, Wuttke W 1989 In vivo demonstration of a paracrine, inhibitory action of met-enkephalin on adrenomedullary catecholamine release in the rat. Endocrinology 125: 624-629 21. Barrett RJ, Wright KF, Taylor DR, Proakis AG 1987 Involvement of dopamine receptor subtypes in dopaminergic modulation of aldosterone secretion in rats. Life Sci 40: 1499-1506 22. Sowers JR, Golub M, Tuck M, Sowers DK 1981 Role of prolactin and the renin-angiotensin system in mediating dopaminergic control of aldosterone secretion in the rat. J Clin Hypertension 3: 114 23. Sowers JR, Tuck ML, Golub MS, Sollars EC 1980 Dopaminergic modulation of aldosterone secretion is independent of alterations in renin secretion. Endocrinology 107: 937-941 24. Pratt JH. Ganaulv A. Parkinson CA. Weinbereer MH 1981 Stimulation of aldosterone secretion by mtoclopramide in humans: apparent independence of renal and pituitary mediation. Metabo.
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Shortly after an annual review has taken place, the multidisciplinary team meets for a feedback discussion. During this meeting the dedicated CF pharmacist can make suggestions to the team regarding any changes, alternatives or additions to therapy. These changes to therapy, if accepted by the team, are communicated to the general practitioner. The annual assessment discussion with the patient is designed to address some issues of unintentional noncompliance7 including: . the patient's ability to take medication . lack of knowledge of medicines . unawareness of instructions for use and forgetfulness.
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Dose: 10mg 3 times daily. Mftoclopramide is a prokinetic. It is contra-indicated in gastro-intestinal obstruction, perforation or haemorrhage and should be avoided where haematemesis or melaena are present.
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Metoclopramide inhibits the central and peripheral effects of apomorphine, induces release of prolactin and produces a transient increase in circulating aldosterone levels and viramune.
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Nausea and vomiting, early satiety and weight loss. While the associated weight reduction might initially positively affect blood sugar control, gastroparesis is an extremely uncomfortable condition, and malnutrition can ensue. Prevalence in unselected diabetic patients has been quantified at about 30 percent. The pathophysiology in diabetes is believed to be an autonomic neuropathy affecting the parasympathetic nervous system and leading to gastric dysrhythmias, antral hypomotility, antral dilatation and decreased gastric tone. Treatment begins with efforts at improved hydration and nutrition. Patients should be counseled to eat frequent small meals consisting of a low-fat, low-fiber, soft diet. High-calorie liquid supplements are often necessary to maintain weight if weight loss is profound. Some are specifically formulated for diabetics. Careful blood glucose monitoring and appropriate insulin adjustments are important during the initiation of these dietary changes. Although exercise improves gastric motility when there is normal autonomic function, it is unlikely to help this patient. Antiemetics may be useful in treating nausea. H2-blockers and protein pump inhibitors are largely ineffective in diabetic gastroparesis, as the effects of acidity are usually minimal. A number of prokinetic agents work at restoring coordinated gastric and small bowel motility. The most common of these, metoclopramide generic, Reglan ; , is fairly effective, particularly as an intravenous medication, but up to 40 percent of patients cannot tolerate it due to its central nervous system and other side effects. It may take several weeks for oral metoclopramide to have its maximal effect. Erythromycin has been shown to improve gastric emptying rates, but cramping and abdominal pain are common side effects. Tegaserod Zelnorm ; is a prokinetic agent recently approved for use in women with irritable bowel syndrome with constipation. While it may prove to be useful for gastroparesis, clinical evidence has not yet established it as a conventional treatment. For refractory cases of diabetic gastroparesis, a gastric electrical stimulator has recently been approved by the FDA. This surgically implanted device, which stimulates the stomach with high-frequency lowenergy stimuli, has been shown to decrease symptoms, reduce hospitalizations and improve quality of life. Though daily aspirin may have a negative impact on reflux, the benefits for reducing the risk of macrovascular complications are substantial enough in Mr. Markey's case to warrant continuing low-dose treatment. Colchicine should be avoided due to concomitant renal insufficiency and risk of further stomach irritation.
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Zopiclone After two nights of nocturnal treatment in sixteen female healthy volunteers with a history of insomnia zopiclone 7.5 mg ; significantly impaired driving performance during the morning session, but not in the afternoon Study 3 ; .48 Driving impairment 10 11 h after administration was comparable to that observed with BACs between 0.05 and 0.08%. In 28 healthy volunteers driving impairment was also pronounced after one night of treatment administration Study 8 ; : 11 and 6 h after bedtime administration zopiclone 7.5 mg ; produced significant SDLP increments of 5.0 and 8.25 cm, respectively, corresponding to BACs of 0.10% and higher.68 A subsequent study Study 9 ; in 30 healthy volunteers found similar impairment 10 h after bedtime administration of zopiclone 7.5 mg ; .69 In comparison to an afternoon driving test to examine the effects of alcohol BAC , 0.05% ; mean SDLP elevation after zopiclone was twice the magnitude of that observed with alcohol. In a driving simulator, 16 healthy volunteers performed a 90 min test, 10 and 12 h after bedtime administration of zopiclone 7.5 mg ; .54 They were instructed to drive with a steady lateral position, and as quickly as possible along the virtual road. SDLP and speed variability were determined. SDLP was significantly increased 10 h after intake, but speed variability was not. Twelve hours after zopiclone administration, these effects were not significant. Zolpidem and zaleplon Design and results from on-the-road driving studies examining zolpidem and zaleplon are summarized in Table 3. Zolpidem In 17 female subjects with a history of insomnia and benzodiazepine use, driving was not significantly impaired 1011 h after one night of bedtime treatment with zolpidem 10 mg Study 7 ; .53 Also, the morning following bedtime administration no significant performance impairment has been reported in a driving simulator.54 Thus, in contrast to the benzodiazepine hypnotics and zopiclone, driving the morning following bedtime administration of the recommended dose of zolpidem seems safe, for instance, metoclopramide gastroparesis.
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