title: A trial of midazolam vs diphenhydramine in prophylaxis of metoclopramide-induced akathisia.
abstract: OBJECTIVE
  The study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia.
  
  
  METHODS
  This randomized, double-blind, and controlled trial aimed to investigate coadministered midazolam vs diphenhydramine in the prophylaxis of metoclopramide-induced akathisia. Patients 18 to 65 years of age who presented to the emergency department with primary or secondary complaints of nausea and/or moderate to severe vascular-type headache were eligible for this study. Patients were randomized to one of the fallowing 3 groups: (1) metoclopramide 10 mg + midazolam 1.5 mg; (2) metoclopramide 10 mg + diphenhydramine 20 mg; (3) metoclopramide 10 mg + placebo. Metoclopramide was administered as a 2-minute bolus infusion. Midazolam, diphenhydramine, and normal saline solution were administered as a 15-minute slow infusion. The whole procedure was observed; and akathisia and sedation scores and vital changes were recorded.
  
  
  RESULTS
  There were significant differences among groups with respect to akathisia (P = .016) and sedation (P < .001). The midazolam group showed the lowest mean akathisia score but the highest mean sedation score. Akathisia scores of the diphenhydramine group were not different from placebo. There were significant differences among groups in terms of changes in mean vital findings such as respiration rates, pulse rates, and systolic blood pressures (P < .05). There were no significant difference among groups in terms of changes in mean diastolic blood pressures (P = .09).
  
  
  CONCLUSIONS
  Coadministered midazolam reduced the incidence of akathisia induced by metoclopramide compared to placebo but increased the rate of sedation. No difference was detected from diphenhydramine. Routine coadministered 20 mg diphenhydramine did not prevent metoclopramide-induced akathisia.
authors.affiliation: Department of Emergency Medicine, Medical Faculty, Pamukkale University, 20070, Denizli, Turkey. bulenterdur@hotmail.com
authors.forename: Bulent
authors.initials: B
authors.lastname: Erdur
authors.forename: Pinar
authors.initials: P
authors.lastname: Tura
authors.forename: Berrin
authors.initials: B
authors.lastname: Aydin
authors.forename: Mert
authors.initials: M
authors.lastname: Ozen
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ergin
authors.forename: Ismet
authors.initials: I
authors.lastname: Parlak
authors.forename: Burhan
authors.initials: B
authors.lastname: Kabay
mesh_terms: D000328:Adult; D017109:Akathisia, Drug-Induced / Q000517:prevention & control*; D000932:Antiemetics / Q000009:adverse effects* / Q000627:therapeutic use; D004155:Diphenhydramine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008787:Metoclopramide / Q000009:adverse effects* / Q000627:therapeutic use; D008874:Midazolam / Q000627:therapeutic use*; D009325:Nausea / Q000188:drug therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000932:Antiemetics; D006993:Hypnotics and Sedatives; D004155:Diphenhydramine; D008787:Metoclopramide; D008874:Midazolam