Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial.
OBJECTIVE
To compare the effects of midazolam, which is a fast and short-acting benzodiazepine, and diphenhydramine, which is a widely used anticholinergic agent, in clinical practice for the treatment of metoclopramide-induced akathisia.


METHODS
All adults older than 17 years given metoclopramide for nausea and vomiting or for headache and who had akathisia were eligible for this clinical, randomized, double-blind trial. Patients were randomized to receive diphenhydramine or midazolam. Subjective, objective, and total akathisia scores and modified Ramsay Sedation Scale scores were recorded. Repeated-measures analysis of variance was used to compare the efficacy and side effects of the medications.


RESULTS
Forty-one (73.3%) of the 56 enrolled patients were women. The mean (+/-SD) age was 39.9 (+/-15.7) years in the diphenhydramine group and 40.9 (+/-16.2) years in the midazolam group. Mean subjective, objective, and total akathisia scores in the first 5 minutes declined considerably in the midazolam group compared with the diphenhydramine group (p < 0.001). However, the mean Ramsay Sedation Scale score in the first 15 minutes increased significantly in the midazolam group compared with the diphenhydramine group (p < 0.001).


CONCLUSIONS
Midazolam can correct the symptoms of metoclopramide-induced akathisia faster than diphenhydramine, but it causes more sedation.
Parlak
Ismet
I
Department of Emergency Medicine, Dokuz Eylul University, Izmir, Turkey.
Erdur
Bulent
B
Parlak
Mine
M
Ergin
Ahmet
A
Ayrik
Cuneyt
C
Tomruk
Onder
O
Turkcuer
Ibrahim
I
Ergin
Nesrin
N
D000328:Adult; D017109:Akathisia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D000704:Analysis of Variance; D004155:Diphenhydramine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000009:adverse effects* / Q000627:therapeutic use; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D004155:Diphenhydramine; D008787:Metoclopramide; D008874:Midazolam