What is the role of Maxeran (Metoclopramide) in head injury?

From the Guidelines

Maxeran is not recommended for head injury management. Maxeran, also known as metoclopramide, is an antiemetic and prokinetic medication primarily used to treat nausea, vomiting, and gastric motility disorders. In head injury cases, metoclopramide should be avoided because it crosses the blood-brain barrier and can affect dopamine receptors in the central nervous system, which could potentially mask neurological symptoms or complicate the neurological assessment of patients with traumatic brain injuries 1.

Key Considerations

• Metoclopramide may lower the seizure threshold, which is particularly concerning in head injury patients who already have an increased risk of seizures.
• For nausea and vomiting in head injury patients, other antiemetics like ondansetron are generally preferred as they have minimal central nervous system effects.
• When managing head injuries, the focus should be on maintaining adequate cerebral perfusion, preventing secondary brain injury, and careful neurological monitoring, rather than using medications that could interfere with neurological assessment.

Alternative Treatments

• Ondansetron (4-8mg IV/oral every 8 hours) is a suitable alternative for managing nausea and vomiting in head injury patients.
• Other treatment options should prioritize minimizing central nervous system effects and avoiding medications that could complicate neurological assessment or increase the risk of seizures.

From the Research

Maxeran in Head Injury

• Maxeran, also known as metoclopramide, is used to treat nausea and vomiting in patients with head injuries 2, 3.
• Studies have compared the effectiveness of metoclopramide and ondansetron in treating post-traumatic nausea and vomiting, with results showing similar effectiveness between the two drugs 2, 3.
• However, metoclopramide has been associated with a higher incidence of side effects such as drowsiness and anxiety 2.
• The use of ondansetron has been shown to be effective in reducing nausea and vomiting in patients with mild head trauma, with a lower risk of side effects compared to metoclopramide 3.
• In patients with severe head injury, the goal of therapy is to avoid secondary brain damage, and analgesia and sedation are an essential part of the therapy 4.
• Other pharmacologic agents such as hypertonic saline, sedatives, benzodiazepines, and barbiturates are also used to reduce intracranial pressure after traumatic brain injury 5.
• The use of ondansetron in children with head injury and symptoms of vomiting has been shown to be safe and effective in reducing return rates to the pediatric emergency department 6.

Comparison of Metoclopramide and Ondansetron

• Both metoclopramide and ondansetron have been shown to be effective in treating nausea and vomiting in patients with head injuries 2, 3.
• However, ondansetron may be a better option due to its lower risk of side effects such as drowsiness and anxiety 2.
• The choice of drug may depend on the individual patient's needs and medical history 3.

Pharmacologic Management of Head Injury

• Pharmacologic agents such as metoclopramide, ondansetron, hypertonic saline, sedatives, benzodiazepines, and barbiturates are used to manage head injury 2, 3, 4, 5.
• The goal of therapy is to avoid secondary brain damage and reduce intracranial pressure 4, 5.
• The use of these agents should be tailored to the individual patient's needs and medical history 5.