Metoclopramide reduces nausea from emergency contraception

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Q&A

Metoclopramide reduces nausea from emergency contraception

J Fam Pract. 2003 July;52(7):512-525

By

David Cunningham, MD

Warren Newton, MD, MPH

BACKGROUND: The effectiveness of emergency hormonal contraception is now well-established, but nausea and vomiting complicate its use and may limit drug absorption and patient compliance. This randomized trial assessed the effectiveness of metoclopramide in attenuating these side effects.
POPULATION STUDIED: The investigators enrolled 141 women presenting to a university health center for emergency contraception. Inclusion criteria were age >18 years, negative pregnancy test, unprotected intercourse within the past 72 hours, and no contraindications to emergency contraception. The authors identified participants as aged 18 to 25 years. The subjects were similar to those seen in family practice, but it would be helpful to have more clinical information, including age, medical/psychological history, and drugs used, including alcohol.
STUDY DESIGN AND VALIDITY: This was a randomized, placebo-controlled, double-blind study using concealed allocation. All participants received 2 doses of 0.5 mg levonorgestrel and 0.1 mg ethinyl estradiol 12 hours apart. Subjects received either metoclopramide 10 mg tablets or matching placebo to take 1 hour before each dose. At enrollment, participants were given a written 12-symptom survey to return by mail within 72 hours of completing treatment.
OUTCOMES MEASURED: The primary outcomes were self-reported nausea (measured on a scale from 1 [least] to 10 [worst]) and vomiting (measured as none, once, more than once). Seven other symptoms were also assessed. Patient satisfaction, pregnancy rates, and cost were not assessed.
RESULTS: No comparison of groups at baseline was given. The overall response rate was 75%, although more controls than subjects returned their surveys (82% vs 63%). Patients receiving metoclopramide reported less nausea (3.22 vs. 4.41 on a 10-point scale; P=.01) and cramping (0.89 vs. 2.22 on a 10-point scale; P<.01) than those receiving placebo. There was no statistically significant difference between the treatment and control groups for all other symptoms, including vomiting, appetite, dizziness, and breast tenderness.

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Metoclopramide reduces nausea from emergency contraception

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