A trial of midazolam vs diphenhydramine in prophylaxis of metoclopramide-induced akathisia

• Published in: The American journal of emergency medicine 2012, Vol.30 (1), p.84-91
• Main Authors: Erdur, Bulent, MD, Tura, Pinar, MD, Aydin, Berrin, MD, Ozen, Mert, MD, Ergin, Ahmet, MD, PhD, MPH, Parlak, Ismet, MD, Kabay, Burhan, MD
• Format: Article
• Language: English
• Subjects: Adult; Akathisia, Drug-Induced - prevention & control; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiemetics - adverse effects; Antiemetics - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Confidence intervals; Diphenhydramine - therapeutic use; Dopamine; Double-Blind Method; Emergency; Emergency medical care; Fallowing; Female; Headaches; Humans; Hypnotics and Sedatives - therapeutic use; Intensive care medicine; Male; Medical sciences; Medical treatment; Metoclopramide - adverse effects; Metoclopramide - therapeutic use; Midazolam - therapeutic use; Nausea - drug therapy; Pharmacology. Drug treatments; Prophylaxis; Restless legs syndrome; Severity of Illness Index; Studies; Treatment Outcome
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.10.007

Abstract Study Objective The study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia. Methods This randomized, double-blind, and controlled trial aimed to investigate coadministered midazolam vs diphenhydramine in the prophylaxis of metoclopramide-induced akathisia. Patients 18 to 65 years of age who presented to the emergency department with primary or secondary complaints of nausea and/or moderate to severe vascular-type headache were eligible for this study. Patients were randomized to one of the fallowing 3 groups: (1) metoclopramide 10 mg + midazolam 1.5 mg; (2) metoclopramide 10 mg + diphenhydramine 20 mg; (3) metoclopramide 10 mg + placebo. Metoclopramide was administered as a 2-minute bolus infusion. Midazolam, diphenhydramine, and normal saline solution were administered as a 15-minute slow infusion. The whole procedure was observed; and akathisia and sedation scores and vital changes were recorded. Results There were significant differences among groups with respect to akathisia ( P = .016) and sedation ( P < .001). The midazolam group showed the lowest mean akathisia score but the highest mean sedation score. Akathisia scores of the diphenhydramine group were not different from placebo. There were significant differences among groups in terms of changes in mean vital findings such as respiration rates, pulse rates, and systolic blood pressures ( P < .05). There were no significant difference among groups in terms of changes in mean diastolic blood pressures ( P = .09). Conclusion Coadministered midazolam reduced the incidence of akathisia induced by metoclopramide compared to placebo but increased the rate of sedation. No difference was detected from diphenhydramine. Routine coadministered 20 mg diphenhydramine did not prevent metoclopramide-induced akathisia.