Saturday, January 5, 2008

Subcutaneous Metoclopramide Therapy for HG?

"It looks like SMT is a safe alternative therapy for this condition, justifying prospective studies for an indication for nausea and vomiting associated with pregnancy," Dr. Barton said. "This agent could represent a new step forward in making pregnancy more comfortable and doing so outside the hospital setting."

For their study, the investigators prospectively collected and analyzed data from January 2000 through February 2002 on 426 women who had singleton or twin gestations and had reported 5 or more days of SMT.

What is metoclopramide?

Metoclopramide increases the rate at which the stomach and intestines
move during digestion. It also increases the rate at which the stomach empties
into the intestines and increases the strength of the lower esophageal sphincter
(the muscle between the stomach and esophagus).
Metoclopramide is used to
treat diabetic gastric stasis (slow
of the stomach), which causes symptoms such as nausea, vomiting, heartburn, decreased
appetite, and prolonged fullness after eating. It is also used to treat gastric
reflux or heartburn (the regurgitation of stomach acid into the esophagus),
prevention of postoperative nausea and
, prevention of nausea and vomiting associated with cancer chemotherapy,
facilitation of small bowel intubation, and to facilitate x-ray examination of
the stomach and intestines. (

"Fifty to 80% of pregnant women will have nausea and vomiting during a pregnancy," said lead researcher John Barton, MD, researcher and clinician at Central Baptist Hospital, division of maternal-fetal medicine, in Lexington, Kentucky. "And if it feels bad enough, or is perceived to be dangerous, it can lead to emergency room visits and sometimes hospitalisation. We wanted to see if these symptoms could be controlled using another antiemetic agent not yet indicated for SMT and if such control could impact the dislocation and costs of hospital visits."

Hyperemesis gravidarum is a complication that occurs in a small percentage of pregnancies but accounts for approximately 78,000 patients annually. Historically, this condition has had high costs in loss of productivity, physical and emotional sequellae, and prolonged and/or recurrent hospital admissions. The use of home subcutaneous metoclopramide therapy appears to be effective, safe, economical, and a way to treat these woeful patients in a familiar, secure, and emotionally supportive environment, which may hasten recovery.

Outcome in these patients was very encouraging. In Group I, 195 (54.7%)
patients had resolution of their hyperemesis gravidarum. This improved to 640
(75.0%) patients in Group II. These are very positive numbers for a single form
of therapy. Historically, this success rate has been achieved with hyperemesis
gravidarum patients largely through the use of multiple therapies/agents in
sequence or in combination, normally requiring prolonged or recurrent
hospitalization. Worsening of the symptoms of hyperemesis gravidarum in spite of
therapy is common; however, it occurred in only 43 (14.3%) patients in Group I
and 59 (6.9%) patients in Group II. This is positive data to recommend home
subcutaneous metoclopramide therapy. The percentage of patients who discontinued therapy due to side effects remained low and fairly constant at 10.6% and 12.7%
in Groups I and II respectively

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