Midazolam vs. Diphenhydramine for the Treatment of Metoclopramide‐induced Akathisia: A Randomized Controlled Trial

• Published in: Academic emergency medicine 2007-08, Vol.14 (8), p.715-721
• Main Authors: Parlak, Ismet, Erdur, Bulent, Parlak, Mine, Ergin, Ahmet, Ayrik, Cuneyt, Tomruk, Onder, Turkcuer, Ibrahim, Ergin, Nesrin
• Format: Article
• Language: English
• Subjects: akathisia; anticholinergics; benzodiazepines; diphenhydramine; metoclopramide; midazolam
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/j.aem.2007.01.021

ObjectivesTo compare the effects of midazolam, which is a fast and short‐acting benzodiazepine, and diphenhydramine, which is a widely used anticholinergic agent, in clinical practice for the treatment of metoclopramide‐induced akathisia. MethodsAll adults older than 17 years given metoclopramide for nausea and vomiting or for headache and who had akathisia were eligible for this clinical, randomized, double‐blind trial. Patients were randomized to receive diphenhydramine or midazolam. Subjective, objective, and total akathisia scores and modified Ramsay Sedation Scale scores were recorded. Repeated‐measures analysis of variance was used to compare the efficacy and side effects of the medications. ResultsForty‐one (73.3%) of the 56 enrolled patients were women. The mean (±SD) age was 39.9 (±15.7) years in the diphenhydramine group and 40.9 (±16.2) years in the midazolam group. Mean subjective, objective, and total akathisia scores in the first 5 minutes declined considerably in the midazolam group compared with the diphenhydramine group (p < 0.001). However, the mean Ramsay Sedation Scale score in the first 15 minutes increased significantly in the midazolam group compared with the diphenhydramine group (p < 0.001). ConclusionsMidazolam can correct the symptoms of metoclopramide‐induced akathisia faster than diphenhydramine, but it causes more sedation.