Prochlorperazine induces akathisia in emergency patients

Drotts, Daniel L.; Vinson, David R.

doi:10.1016/s0196-0644(99)80048-1

Cited by 82 publications

(55 citation statements)

References 26 publications

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“…15 Our incidence of akathisia with promethazine appears much lower than the 16% to 44% noted in ED patients receiving prochlorperazine 16,17 or the up to 72% incidence with droperidol if every patient who reported anxiety or restlessness was considered to have some degree of akathisia. 5 In our previous trial, IV droperidol (1.25 mg), but not prochlorperazine (10 mg) or metoclopramide (10 mg), was superior to IV fluids for the control of undifferentiated nausea among ED patients.…”

Section: Discussionmentioning

confidence: 82%

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Braude

Crandall

2008

Academic Emergency Medicine

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Objectives: The authors sought to compare ondansetron and promethazine among emergency department (ED) patients with undifferentiated nausea. The hypothesis was that ondansetron was not inferior to promethazine and that rates of adverse effects were similar.Methods: This was a randomized double-blind noninferiority clinical trial conducted in an urban academic ED. A convenience sample of nonpregnant adults with at least 40 mm of self-reported nausea measured on a 100-mm visual analog scale (VAS) were enrolled. Patients who had already received more than 1 L of intravenous fluid or an antiemetic agent were excluded. Subjects were block-randomized in groups of 10 to either 4 mg of ondansetron or 25 mg of promethazine delivered intravenously. The primary outcome was change in nausea over 30 minutes. The authors used a 15-mm margin of noninferiority. Secondary endpoints included changes in anxiety, sedation, and other adverse effects. Analyses included t-tests, tests for proportions, and 95% confidence intervals (CIs).Results: A total of 120 subjects completed the study, 60 in each arm. Baseline nausea, anxiety, and sedation scores were similar. Ondansetron and promethazine reduced nausea similarly (ondansetron )34 mm, promethazine )36 mm; difference )2 mm; 95% CI = )13 to 8 mm). The reduction in anxiety was similar (ondansetron )13 mm, promethazine )14 mm; difference )1 mm; 95% CI = )10 to 10 mm). Promethazine was associated with significantly more sedation than ondansetron (ondansetron 5 mm, promethazine 19 mm; difference 14 mm; 95% CI = 5 to 24 mm). There were no cases of akathisia in the ondansetron group and 2 cases in the promethazine group.Conclusions: Promethazine and ondansetron have similar efficacy in reducing nausea among ED patients. Change in anxiety was similar, but promethazine was associated with greater sedation.ACADEMIC EMERGENCY MEDICINE 2008; 15:209-215 ª

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Section: Discussionmentioning

confidence: 82%

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Braude

Crandall

2008

Academic Emergency Medicine

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“…The akathisia rates were similar in the two groups and consistent to those reported in other studies. 8,9 The combination of lidocaine and IV prochlorperazine showed no benefit in improving patient outcomes over time compared with IV prochlorperazine alone.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, many patients report intolerance to it. 9,10 Therefore, the search for alternative medication continues.…”

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confidence: 99%

Intranasal Lidocaine for the Treatment of Migraine Headache: A Randomized, Controlled Trial

Blanda

Rench

Gerson

et al. 2001

Academic Emergency Medicine

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Abstract. Objective: To evaluate the effect of intranasal lidocaine for immediate relief (5 minutes) of migraine headache pain. Methods: A randomized, double-blind, placebo-controlled clinical trial at two university-affiliated community teaching hospitals enrolled patients 18-50 years old with migraine headache as defined by the International Headache Society. Patients who were pregnant, lactating, known to abuse alcohol or drugs, or allergic to one of the study drugs, those who used analgesics within two hours, or those with a first headache were excluded. Statistical significance was assessed by using chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables. Patients rated their pain on a 10-centimeter visual analog scale (VAS) prior to drug administration and at 5, 10, 15, 20, and 30 minutes after the initial dose. Medication was either 1 mL of 4% lidocaine or normal saline (placebo) intranasally in split doses 2 minutes apart and intravenous prochlorperazine. Medications were packaged so physicians and patients were unaware of the contents. Successful pain relief was achieved if there was a 50% reduction in pain score or a score below 2.5 cm on the VAS. Results: Twentyseven patients received lidocaine and 22 placebo. No significant difference was observed between groups in initial pain scores, 8.4 (95% CI = 7.8 to 9.0) lidocaine and 8.6 (95% CI = 8.0 to 9.2) placebo (p = 0.75). Two of 27 patients (7.4%, 95% CI = 0.8, 24.3) in the lidocaine group and three of 22 patients (13.6%, 95% CI = 2.8 to 34.9) in the placebo group had immediate successful pain relief (p = 0.47), with average pain scores of 6.9 (95% CI = 5.9 to 7.8) and 7.0 (95% CI = 5.8 to 8.2), respectively. No difference in pain relief was detected at subsequent measurements. Conclusion: There was no evidence that intranasal lidocaine provided rapid relief for migraine headache pain in the emergency department setting.

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“…While proving that the A/J Vnn1/ 3 alleles are indeed causal would require further genetic dissection, we demonstrate that cystamine coadministration can completely prevent the onset of a haloperidol-induced movement disorder in mice, which resembles that of human Parkinson's disease. Since other commonly used drugs [e.g., prochlorperazine (Drotts and Vinson 1999) and metoclopramide (Moos and Hansen 2008)] cause EPS (Orti-Pareja et al 1999), this raises the possibility that cystamine coadministration could prevent the EPS caused by these drugs. Of note, there are three human orthologs of the murine pantetheinase genes (VNN1, VNN2, and VNN3) (Martin et al 2001).…”

Section: Discussionmentioning

confidence: 99%

A Pharmacogenetic Discovery: Cystamine Protects Against Haloperidol-Induced Toxicity and Ischemic Brain Injury

Zhang

Zheng

et al. 2016

Genetics

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Haloperidol is an effective antipsychotic agent, but it causes Parkinsonian-like extrapyramidal symptoms in the majority of treated subjects. To address this treatment-limiting toxicity, we analyzed a murine genetic model of haloperidol-induced toxicity (HIT). Analysis of a panel of consomic strains indicated that a genetic factor on chromosome 10 had a significant effect on susceptibility to HIT. We analyzed a whole-genome SNP database to identify allelic variants that were uniquely present on chromosome 10 in the strain that was previously shown to exhibit the highest level of susceptibility to HIT. This analysis implicated allelic variation within pantetheinase genes (Vnn1 and Vnn3), which we propose impaired the biosynthesis of cysteamine, could affect susceptibility to HIT. We demonstrate that administration of cystamine, which is rapidly metabolized to cysteamine, could completely prevent HIT in the murine model. Many of the haloperidol-induced gene expression changes in the striatum of the susceptible strain were reversed by cystamine coadministration. Since cystamine administration has previously been shown to have other neuroprotective actions, we investigated whether cystamine administration could have a broader neuroprotective effect. Cystamine administration caused a 23% reduction in infarct volume after experimentally induced cerebral ischemia. Characterization of this novel pharmacogenetic factor for HIT has identified a new approach for preventing the treatment-limiting toxicity of an antipsychotic agent, which could also be used to reduce the extent of brain damage after stroke. KEYWORDS pharmacogenetics; haloperidol toxicity H ALOPERIDOL is a potent D2 dopamine receptor (DRD2) antagonist that is used to treat psychotic disorders (Beresford and Ward 1987). However, haloperidol-induced alterations in the extrapyramidal motor system depress the ability to initiate voluntary movements. As a consequence, characteristic extrapyramidal symptoms (EPS), which include tremors, Parkinsonian rigidity, and decreased spontaneous movement, develop in 40-76% of human subjects that are chronically treated with haloperidol (Parkes 1982;Soares-Weiser and Fernandez 2007). We recently analyzed a murine genetic model of haloperidol-induced toxicity (HIT) (Zheng et al. 2015) in which the Parkinsonian-like symptoms developing in haloperidol-treated mice resemble those observed in drug-treated human patients (Crowley et al. 2012a). The 27 inbred strains evaluated in this genetic model exhibit substantial variability in susceptibility to HIT (Crowley et al. 2012b). For example, C57BL/6 mice are completely resistant, while A/J mice are highly susceptible to the Parkinsonian hypokinesia associated with HIT. We found that allelic differences in Abcb5, a member of the ABC-transporter gene family, affected susceptibility to this manifestation of HIT by regulating the level of haloperidol in the brain (Zheng et al. 2015). This pharmacogenetic effect is of importance, since haloperidol is oxidatively metabolized to a ...

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Prochlorperazine induces akathisia in emergency patients

Cited by 82 publications

References 26 publications

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Ondansetron versus Promethazine to Treat Acute Undifferentiated Nausea in the Emergency Department: A Randomized, Double‐blind, Noninferiority Trial

Intranasal Lidocaine for the Treatment of Migraine Headache: A Randomized, Controlled Trial

A Pharmacogenetic Discovery: Cystamine Protects Against Haloperidol-Induced Toxicity and Ischemic Brain Injury

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