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Palliative cancer care - nausea & vomiting - Management
What issues do I need to be aware of before prescribing a prokinetic?
- Do not give prokinetics concurrently with drugs with antimuscarinic activity (e.g. cyclizine, hyoscine), because antimuscarinic drugs competitively block the action of prokinetics.
- Metoclopramide:
- Metoclopramide is generally given orally three to four times a day. It may be given as a subcutaneous injection or infusion.
- Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises. These reactions are more common in younger people (particularly girls and young women) and people who are also taking other drugs known to cause extrapyramidal effects. They generally occur within a few days of starting treatment and subside within 24 hours of stopping metoclopramide. Injection of procyclidine, 5–10 mg intravenously or intramuscularly, will abort a dystonic attack.
- Other adverse effects include drowsiness, restlessness, and diarrhoea.
- Domperidone:
- Domperidone can be given orally or rectally.
- Domperidone is not as effective as metoclopramide, but it is less likely to cause central adverse effects, such as sedation and dystonic reactions.
[Twycross et al, 2002]
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