title: Tropisetron versus metoclopramide for the treatment of nausea and vomiting in the emergency department: A randomized, double-blinded, clinical trial.
abstract: OBJECTIVE
  We aimed to compare the relative efficacy of tropisetron and metoclopramide in treating nausea/vomiting in undifferentiated ED patients.
  
  
  METHODS
  We undertook a randomized, double-blinded, clinical trial. Adult patients requiring treatment for nausea/vomiting were randomly assigned to either tropisetron (5 mg) or metoclopramide (10 mg), by i.v. bolus. The primary end-point was incidence of vomiting. Secondary end-points were decrease in nausea score from baseline (0-100 VAS), the requirement of 'rescue' anti-emetics, ongoing nausea over 48 h and side-effects.
  
  
  RESULTS
  Fifty patients were enrolled in each group. The demographic variables, presenting complaints and nausea scores at baseline did not differ (P > 0.05). By 180 min, two (4.0%) and nine (18.0%) patients had vomited in the tropisetron and metoclopramide groups respectively (difference 14.0%, 95% CI 0.1-28.0, P= 0.05). Also, there were two and 20 episodes of vomiting respectively. Vomiting rates were 0.02 and 0.16 episodes/person-hour (difference 0.14 episodes/person-hour, 95% CI 0.07-0.21, P < 0.001) respectively. By 60 min and thereafter, the decrease in nausea score from baseline was greater (although not significantly so) in the tropisetron group. At 180 min, the decreases were 47.9 mm and 37.0 mm respectively (difference 10.9 mm, 95% CI -0.7-22.6). Five (10.0%) and 13 (26.0%) patients required a rescue anti-emetic respectively (difference 16.0%, 95% CI -0.7-32.7, P= 0.07). Of patients followed up, 13/47 (27.7%) and 20/49 (40.8%) had ongoing nausea respectively (difference 13.2%, 95% CI -7.7-34.0, P= 0.25). The tropisetron group had less akathisia.
  
  
  CONCLUSIONS
  Tropisetron was associated with a significantly lower vomiting rate and shows promise as an alternative anti-emetic in the ED.
authors: Department of Medicine, University of Melbourne Department of Medicine, Austin Hospital, Melbourne, Victoria, Australia. david.taylor@austin.org.au
authors: John
authors: J
authors: Chae
authors: David McD
authors: DM
authors: Taylor
authors: Albert G
authors: AG
authors: Frauman
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use*; D004311:Double-Blind Method; D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy*; D000077526:Tropisetron; D014839:Vomiting / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000932:Antiemetics; D007211:Indoles; D000077526:Tropisetron; D008787:Metoclopramide