In this episode, I’ll discuss the most effective and safest therapies for nausea/emesis in adult patients presenting to the emergency department (ED).
In the Annals of Emergency Medicine a group of authors have published a systematic review and meta-analysis to identify the best medications to use for nausea and emesis in patients in the ED.
Only randomized controlled trials of adult ED patients were included, and the outcomes were:
- Change in nausea intensity at 30 minutes
- Need for rescue drug
- Significant adverse reaction
A total of 13 studies were included in the review. Unfortunately, the medication ranked as superior for not needing a rescue drug was IV tropisetron, which is not available in the US. IV ondansetron was ranked as superior for not causing significant adverse reactions.
When a minimally contextualized framework was applied, the only US agent that was definitely among the most effective was IV prochlorperazine. IV metoclopramide and IV droperidol were judged in this framework to be possibly among the most effective, and oral ondansetron was definitely among the least effective.
When adverse events were considered, IV metoclopramide, IV droperidol, and IV promethazine were considered to be definitely among the most harmful.
This study adds to the available information for clinicians to consider because a previous Cochrane review did not identify a medication that was superior for nausea and emesis in the ED.
The study design using a minimally contextualized framework is probably the reason these authors found medications they considered superior, as this design leads to a focus on single medication performance.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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