The effect of metoclopramide on the absorption of effervescent aspirin in migraine.

Abstract

1 The absorption of effervescent aspirin was studied in two groups of patients during attacks of migraine. The first group received effervescent aspirin alone whilst the second group received intramuscular metoclopramide before effervescent aspirin. 2 After effervescent aspirin alone there was significant impairment in the rate of aspirin absorption during migraine attacks compared with the rate of aspirin absorption in normal volunteers and in the same patients when headache‐free. 3 When metoclopramide was given before effervescent aspirin the rate of aspirin absorption during migraine attacks was not significantly different from that obtained in normal volunteers given effervescent aspirin alone or from that obtained in the patients themselves when given both metoclopramide and effervescent aspirin when headache‐free. 4 It is concluded that the impairment of absorption of effervescent aspirin during migraine attacks is related to impaired gastro‐intestinal motility with delayed gastric emptying and that this impaired motility can be overcome by parenteral metoclopramide.

The Influence of Thiethylperazine on the Absorption of Effervescent Aspirin in Migraine

“…Middlesex TW8 9BD ** Deputy Director, Poisons Unit, Guy's Hospital, London SEI attack was not significantly different from that obtained from the patients themselves when given both metoclopramide and effervescent aspirin when headache-free (Volans, 1975). Moreover all twenty patients in the study needed no further medication and reported themselves virtually symptom-free within 2 hours.…”

“…The investigative procedure outlined is identical to that described by Volans (1975) in his studies of absorption of aspirin during a migraine attack and the effect upon it of metoclopramide. Though ideally it would have been preferable to study the same patient in several attacks, to assess their response to different treatments, because of the episodic nature of the migraine syndrome, and the temporary character of the population in the vicinity of the clinic, it was only rarely that the same patient attended during more than one attack.…”

“…It was therefore decided to perform the studies with metoclopramide and thiethylperazine consecutively and where possible to re-test each patient under control conditions when headachefree. The results from the metoclopramide study have already been reported (Volans, 1975) and though no attempt was made to match the patients treated with thiethylperazine with the metoclopramide group regarding age, sex, weight and duration and severity of symptoms these variables were recorded for each subject.…”

Acute pharmacotherapy of migraine, tension-type headache, and cluster headache

“…During migraine attacks the stomach is relatively atonic and the absorption of orally administered drugs is delayed [32], but the absorption can be normalised by the prokinetic and anti-emetic drug metoclopramide [33]. The combination of lysine acetylsalicylic acid and metoclopamide (56%) was as effective as sumatriptan 100 mg (53% relief) and both were superior to placebo (24%) in one RCT [34].…”

Plasma salicylate levels after soluble and effervescent aspirin.

“…As gastric stasis is present in migraine (Kaufman & Levine, 1936;Kreel, 1969) it is important that the analgesic is given in the most readily absorbed formulation. Volans (1974Volans ( , 1975a and Wainscott, Kaspi & Volans (1976) used effervescent aspirin in their studies of salicylate absorption during migraine headache, but no claims have ever been made for the efficacy of effervescent aspirin in migraine compared with other rapidly absorbed formulations other than its pleasant taste and low sodium content (Volans, 1975b). Effervescent preparations of aspirin (Leonards, 1963) Saltzman (1948) using an AmincoBowman spectrophotofluorimeter.…”