From the FDA Drug Label
Metoclopramide Injection, USP should be given intramuscularly near the end of surgery. The usual adult dose is 10 mg; however, doses of 20 mg may be used To Facilitate Small Bowel Intubation If the tube has not passed the pylorus with conventional maneuvers in 10 minutes, a single dose (undiluted) may be administered slowly by the intravenous route over a 1 to 2 minute period.
The antiemetic medication listed is Metoclopramide.
- Metoclopramide is used for the prevention of postoperative nausea and vomiting. However, the Pharmaceutical Benefits Scheme (PBS) in Australia is not mentioned in the provided drug label. Therefore, no conclusion can be drawn about the antiemetic medications listed on the PBS in Australia based on this information 1.
From the Research
In Australia, the most effective antiemetic medications listed on the Pharmaceutical Benefits Scheme (PBS) for managing nausea and vomiting include ondansetron, metoclopramide, prochlorperazine, and domperidone, with ondansetron being the most effective option, as supported by the most recent study 2.
Overview of Antiemetic Medications
The PBS-listed antiemetics work through different mechanisms to prevent or reduce nausea and vomiting.
- Ondansetron is a 5-HT3 receptor antagonist often used for chemotherapy-induced or postoperative nausea.
- Metoclopramide and domperidone are dopamine antagonists that also improve gastric emptying.
- Prochlorperazine is a phenothiazine that blocks dopamine receptors in the chemoreceptor trigger zone.
Efficacy Comparison
A network meta-analysis comparing the efficacy of ondansetron, domperidone, and metoclopramide in treating vomiting in pediatric patients with acute gastroenteritis found that ondansetron was significantly more effective than placebo in achieving cessation of vomiting 2.
- While domperidone and metoclopramide also showed improved efficacy compared to placebo, these differences were not statistically significant.
- Ondansetron emerged as the most effective intervention, followed by domperidone and metoclopramide.
Prescription and Cost
PBS coverage typically requires a prescription from a doctor, and the cost to patients will depend on whether they have a concession card and if they've reached the PBS safety net threshold.
- The specific antiemetic prescribed will depend on the cause of nausea, patient factors, and potential side effects, so consultation with a healthcare provider is essential for appropriate treatment selection.
- Previous studies have also compared the efficacy of ondansetron and metoclopramide in various settings, including chemotherapy-induced nausea and vomiting 3, 4 and postoperative nausea and vomiting 5, 6.