From the Guidelines
Reglan (metoclopramide) is a crucial component of the migraine cocktail, primarily used to treat accompanying nausea and improve gastric motility, thereby enhancing the absorption of other medications 1.
Key Points About Reglan in Migraine Treatment
- Reglan works as an antiemetic to relieve nausea and vomiting, and it increases gastric emptying to facilitate the absorption of pain medications.
- The typical dose of Reglan in a migraine cocktail is 10 mg, administered intravenously or orally, 20 to 30 minutes before or with a simple analgesic, NSAID, or ergotamine derivative 1.
- Reglan provides additional benefit by blocking dopamine receptors in the brain, which may directly help reduce migraine pain.
- When combined with other components of the migraine cocktail, such as NSAIDs, antihistamines, and sometimes triptans or DHE, Reglan enhances the overall effectiveness of the treatment.
Important Considerations
- Patients should be aware that Reglan can cause side effects, including restlessness, drowsiness, diarrhea, muscle weakness, and dystonic reaction 1.
- Due to the potential for side effects, Reglan is typically used for acute treatment rather than daily prevention.
Clinical Use
- Reglan is often used in conjunction with other medications to provide synergistic analgesia and treat associated symptoms of migraine.
- The efficacy of Reglan as an adjunctive therapy is rated as 2 on a scale of 1 to 4, with 4 being most effective 1.
From the Research
Role of Reglan in Migraine Cocktail
- Reglan, also known as metoclopramide, is used as an antiemetic and has shown efficacy in alleviating migraine pain 2, 3, 4, 5, 6.
- Studies have investigated the use of metoclopramide as a primary therapy for acute migraine, with some showing its effectiveness in reducing headache outcomes 4, 5.
- Metoclopramide has been compared to other anti-migraine drugs, including sumatriptan, with results showing that it can be an effective alternative for some patients 3, 5, 6.
- The optimal dose of metoclopramide for migraine treatment is not yet established, but 10 mg intravenously has been shown to be effective with minimal side effects 4, 5.
- Metoclopramide has been used in combination with other medications, such as sumatriptan, to treat migraine, with some studies showing improved efficacy 3.
Efficacy and Safety
- Metoclopramide has been shown to be effective in reducing headache outcomes, including pain relief and headache-free symptoms 4, 5.
- The medication has been found to be generally well-tolerated, with common side effects including drowsiness and akathisia 4, 5.
- Metoclopramide has been compared to other medications, including granisetron, ketorolac, and prochlorperazine, with varying results 5.
- The use of metoclopramide for migraine treatment has been found to be associated with a lower incidence of mild side effects compared to some other medications 5.
Comparison to Sumatriptan
- Metoclopramide has been compared to sumatriptan in several studies, with results showing that it can be an effective alternative for some patients 3, 6.
- One study found that metoclopramide was not non-inferior to sumatriptan for alleviating acute migraine pain 6.
- Another study found that combining sumatriptan with metoclopramide provided relief in some migraineurs who failed to achieve adequate relief with a triptan alone 3.