The Montefiore Metoclopramide Study
The Montefiore Metoclopramide Study
Metoclopramide is a dopamine antagonist frequently used for the treatment of nausea,
 vomiting, and migraine headaches in Emergency Departments. However, little research has
 focused on the optimal dose of metoclopramide for treatment of nausea in the emergency
 department. We propose a randomized, double-blind, placebo controlled trial to investigate
 the optimal dose of metoclopramide for treatment of nausea.
The most effective dose of metoclopramide for treatment of nausea in the emergency department
 setting has not been thoroughly investigated. One pilot study among emergency department
 patients in Australia found no statistical difference between 10 mg and 0.4
 milligrams/kilogram; another investigation suggests that the anti-emetic effect of 10
 milligrams of metoclopramide is no more effective than placebo. In contrast, investigations
 focusing on chemotherapy patients and post-operative patients suggest that higher dosage
 metoclopramide is more effective in treating nausea and vomiting. This emergency department
 study will compare the anti-emetic efficacy of 10 milligrams and 20 milligrams of
 metoclopramide by using the visual analog scale.

 In addition to evaluation of dose, we will evaluate one of the most common side affects of
 metoclopramide, akathisia. Akathisia is characterized by a subjective component of
 restlessness and an objective component in the form of the inability to remain motionless.
 Anti-cholinergic medications are known to reduce extrapyramidal symptoms such as akathisia
 when dopamine function is impaired in the basal ganglia. In fact, the use of diphenhydramine
 has been shown to reduce the incidence of akathisia in patients receiving a different
 anti-emetic, prochlorperazine. However, no research has focused on the use of
 anti-cholinergic medications to reduce metoclopramide induced akathisia. This investigation
 will assess the use of 25 mg of diphenhydramine in preventing metoclopramide induced
 akathisia in ED patients being treated for nausea/vomiting.
Inclusion Criteria:

 -  primary or secondary complaints of nausea/vomiting

 -  age 21-65

 Exclusion Criteria:

 -  pregnancy

 -  use of anti-histamine or dopamine antagonist as outpatient and/or within last 24 hours
 of presentation

 -  previous adverse reaction to study medications

 -  use of opioid medications prior to study start time within that ED visit