A Comparison of Metoclopramide and Ondansetron Efficacy for the Prevention of Nausea and Vomiting In Patients Suffered From Renal Colic

Ondansetron in dogs with nausea associated with vestibular disease: A double-blinded, randomized placebo-controlled crossover study

Background

Nausea and emesis can be, among other signs, common manifestations of acute vestibular system dysfunction in dogs. Currently, antiemetic drugs, such as maropitant and metoclopramide, are used commonly, but do not appear to control nausea. A non‐placebo‐controlled preliminary study suggested good efficacy of 5‐HT3‐receptor antagonists, such as ondansetron, against nausea in dogs with vestibular syndrome.

Objectives

To assess and confirm the effect of ondansetron on behavior suggestive of nausea in dogs with vestibular syndrome.

Animals

Fourteen dogs with vestibular syndrome and clinical signs of nausea presented to a neurology service.

Methods

Placebo‐controlled, double‐blinded, crossover study. Behavioral assessment was performed hourly for 4 hours using an established numerical rating scale. The criteria salivation, lip licking, vocalization, restlessness, lethargy, and general nausea were scored. The occurrence of emesis was recorded. After scoring at T0 (pre‐dose) and T2 (2 hours post‐dose) either ondansetron (0.5 mg/kg) or placebo was injected IV. Two hours post‐dose, treatments were switched. Blood samples were collected to measure serum arginine vasopressin (AVP) concentration, which previously has been shown to correlate with clinical signs of nausea.

Results

Clinical resolution of nausea was observed 1 hour after administration of ondansetron, whereas serum AVP concentration decreased 4 hours after ondansetron administration.

Conclusion and Clinical Importance

Administration of ondansetron IV is beneficial for dogs with nausea secondary to acute vestibular syndrome. Ondansetron substantially and rapidly decreased clinical signs of nausea behavior and stopped emesis.

The use of ondansetron for the treatment of nausea in dogs with vestibular syndrome

Background

Vestibular syndrome is often accompanied by nausea. Drugs currently approved for its treatment have been developed to stop vomiting but not nausea. The efficacy of 5-HT₃ receptor antagonists to reduce nausea has been described for chemotherapy, but not for nausea secondary to vestibular disorders.

Methods

Sixteen dogs with vestibular syndrome-associated nausea were included in the open-label, multicentre study. The intensity of nausea-like behaviour was analysed before ondansetron administration (0.5 mg/kg i.v.) and 2 h afterwards, using a validated 5-point-scale. The occurrence and frequency of salivation, lip licking, restlessness, vocalisation, lethargy, and vomiting were assessed.

Results

All dogs initially showed signs of nausea, whereas only 31% showed vomitus. The intensity of nausea was significantly reduced in all dogs (p ≤ 0.0001) 2 h after ondansetron administration, including the clinical signs of nausea analysed in 11 dogs (salivation [p = 0.0078], lip licking [p = 0.0078], restlessness [p = 0.0039], and lethargy [p = 0.0078]) except for vocalisation (p > 0.9999).

Conclusions

The results provide preliminary evidence of the potential benefit of ondansetron in the treatment of nausea, which was present in all examined dogs. Vomiting was only observed in 5 dogs indicating that nausea can occur separately and should not be perceived only as a preceding stimulation of the vomiting centre.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-02931-9.

Comparison of the Effects of Metoclopramide and Ondansetron on Emergency Service Observation Times in Acute Gastroenteritis-Related Nausea and Vomiting Cases

Objectives:

The aim of the present study was to compare the effect of metoclopramide and ondansetron treatments on the emergency department observation time in acute gastroenteritis-related nausea and vomiting (NV).

Methods:

The study was conducted retrospectively on 297 patients diagnosed with acute gastroenteritis in a training and research hospital’s emergency service observation unit within 6 months. Patients with gastroenteritis who were diagnosed with NV were divided into two groups according to the treatment they received in the observation unit. Patients who received 4 mg ondansetron slow infusion therapy were classified as Group 1, and patients who received 10 mg metoclopramide slow infusion therapy were classified as Group 2.

Results:

The average age of the patients was 39.57±18.75 years. Of the 297 participants, 56.6% (168) were female. Among them, 51.5% (153) received ondansetron (Group 1), and 48.5% (144) received metoclopramide (Group 2). 6.9% weakness–numbness and 4.9% akathisia were detected due to metoclopramide use. There were no adverse effects related to ondansetron use. The duration of observation ranged from 19 to 75 min in Group 1 and from 42 to 122 min in Group 2. Nineteen (13.2%) patients in Group 2 and 5 (3.3%) patients in Group 1 revisited the emergency department within 24 h due to ongoing complaints.

Conclusion:

In conclusion, side effects of weakness and akathisia due to metoclopramide use were observed. However, no side effects were observed due to ondansetron use. Additionally, the use of ondansetron showed a shorter observation time and less recurrent admission to the emergency department. Therefore, ondansetron is a more effective drug in the treatment of NV associated with acute gastroenteritis.