Metoclopramide 15mg modified-release capsules

Acute Upper Gastrointestinal Bleeding (UGIB) is a critical condition where endoscopy is often hindered by poor visibility. This meta-analysis assesses the safety and efficacy of metoclopramide as a pre-endoscopic aid to improve visualization. Databases including PubMed, Cochrane Library, ScienceDirect, and Google Scholar were searched from inception till October 2024. Review Manager 5.4.1 software was utilized to combine standard and weighted mean differences as well as risk ratios for continuous and dichotomous outcomes, respectively. Quality assessment was carried out by the Cochrane Risk of Bias Tool 2.0. Publication bias was assessed through funnel plots. GRADE assessment was conducted to determine the certainty of the evidence. The protocol of this review was registered on PROSPERO under the ID CRD42024569658. A total of eight studies were included, resulting in a pooling of 665 patients. Metoclopramide significantly increases the Endoscopic Visualization Score of the Fundus (SMD = 0.30, 95% CI: [0.12, 0.47]; p = 0.0008; I 2 = 0%), Endoscopic Visualization Score Body (SMD = 0.25, 95% CI: [0.07, 0.42]; p = 0.006; I 2 = 0%), Endoscopic Visualization Score Antrum (SMD = 0.23, 95% CI: [0.05, 0.40]; p = 0.01; I 2 = 0%), and Endoscopic Visualization Score Total (SMD = 0.32, 95% CI: [0.15, 0.50]; p = 0.0003; I 2 = 0%). Outcomes such as length of hospital stay, re-endoscopy, RBC transfusion units, second look endoscopy, duration of endoscopy, and mortality showed insignificant results. In conclusion, metoclopramide usage improved the endoscopic visualization, but it showed no significant results when evaluated for the secondary outcomes. However, there is a clear need for more full-length clinical trials demonstrating the safety and efficacy of metoclopramide to establish robust evidence.

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BackgroundGiven the limited head-to-head trials comparing the outcomes of pre-endoscopy erythromycin and metoclopramide for upper gastrointestinal bleeding (UGIB), a network meta-analysis (NMA) and component NMA were conducted.MethodsA comprehensive review of the Medline, Embase, and Cochrane databases was conducted for randomized controlled trials comparing pre-endoscopy erythromycin or metoclopramide for UGIB with or without gastric lavage (GL) to placebo and/or GL. The primary outcome was the adequate visualization of the mucosa. The secondary outcomes were endoscopy visualization score, endoscopy duration, diagnosis established at initial endoscopy, second-look endoscopy, blood transfusions, mortality, and duration of hospitalization.ResultsA total of 16 studies (1,447 patients) were included. No significant differences were observed between erythromycin and metoclopramide in all the outcomes, but erythromycin had significantly better outcomes than the control group in terms of endoscopic visualization score (standardized mean difference, 0.58; 95% confidence interval [CI], 0.26-0.91), adequate mucosal visualization (risk ratio, 1.55; 95% CI, 1.18-2.04), second-look endoscopy, transfusion requirements, and duration of hospitalization. Component network meta-analysis revealed that erythromycin, but not metoclopramide or GL, provided significantly better endoscopic visualization than the placebo.ConclusionsErythromycin should be considered before UGIB endoscopy. The current data do not support the use of metoclopramide or GL.

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BackgroundHeadache following traumatic brain injury (TBI) is a common, yet disabling, disorder with diverse mechanisms and treatment needs that remain poorly defined. Pharmacological regimens are the primary source of remedies for individuals with post-traumatic headaches (PTH). The main objective of this review is to describe the efficacy of pharmacological medications for the treatment of PTH with a specific focus on the effect of these medications on headache characteristics and headache-related quality of life (QoL).MethodsThis systematic review (CRD42024537719) followed PRISMA and SWiM guidelines. PubMed, CINAHL, Scopus, PsycINFO and the Cochrane Library were searched in April 2024 for peer-reviewed articles published in English between 2009 and 2024. Eligible studies included randomized controlled trials, controlled cohort studies, and systematic reviews or meta-analyses evaluating pharmacological treatments for PTH in adults. Studies were excluded if they did not assess outcomes related to PTH pain, only included pediatric populations, used animal models, investigated only non-pharmacological interventions, were case reports, narrative reviews, editorials or conference abstracts, or did not involve human participants with TBI-related headache. Risk of bias was assessed using RoB-2 for Randomized controlled trials (RCTs) and ROBINS-I for the non-randomized studies of the effects of interventions.ResultsSixteen studies were included in the final review, comprising retrospective observational (n = 7), non-randomized prospective (n = 4) and randomized controlled trials (n = 5). Most studies reported some improvements in headache frequency and intensity following pharmacological treatment, although findings for headache-related QoL were inconsistent. Erenumab showed potential benefits for persistent PTH in small, uncontrolled studies of civilian samples. However, findings on its impact on headache-related QoL should be interpreted with caution, given the high discontinuation rate observed. Prazosin demonstrated similar benefits in military populations, with minimal side effects. In the acute care setting, metoclopramide, co-administered with diphenhydramine to minimize side effects, was associated with short-term relief of headache symptoms. Of the RCTs, only two had a low risk of bias, of which only one specifically focused on PTH.ConclusionsPharmacological treatments for PTH may provide improvements in headache frequency and intensity; however, evidence for their efficacy is limited and inconsistent. Given the limited high-quality evidence overall, no specific clinical recommendations can be made at this time. Future research should prioritize rigorous, controlled studies, particularly comparative effectiveness trials, and explore holistic, personalized approaches that incorporate treatment of psychiatric comorbidities and consider patient context.

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Introduction: Upper gastrointestinal bleeding (UGIB) is a common emergency where poor endoscopic visualization due to retained blood and clots hampers diagnosis and therapy. Prokinetic agents and nasogastric (NG) lavage are used to improve visualization, but their comparative effectiveness remains unclear. This study evaluated the comparative efficacy of prokinetics - with or without NG lavage - versus NG lavage alone, prokinetics alone, or placebo in improving endoscopic visualization in UGIB.MethodsA systematic search of five databases up to April 2025 identified randomized controlled trials (RCTs) comparing erythromycin, metoclopramide, NG lavage, or combinations against placebo. Network meta-analysis using a frequentist random-effects model assessed the primary outcome of adequate visualization. Secondary outcomes included visualization score, endoscopy duration, and blood transfusion units within 24 h. Risk ratios (RRs) and standardized mean differences (SMDs) were calculated. Treatments were ranked using Surface Under the Cumulative Ranking curve (SUCRA).ResultsA total of 10 RCTs (1,083 patients) were included: erythromycin (n = 226), erythromycin+NG lavage (n = 186), metoclopramide (n = 34), metoclopramide+NG lavage (n = 143), NG lavage alone (n = 333), and placebo (n = 161). Erythromycin + NG lavage ranked highest for adequate visualization (RR: 2.49; 95% CI: 1.57-3.95; SUCRA: 92%), followed by erythromycin (RR: 2.24; 95% CI: 1.56-3.21) and NG lavage (RR: 1.70; 95% CI: 1.06-2.73). Erythromycin improved visualization score (SMD: 0.86; 95% CI: 0.36-1.36; SUCRA: 73%). No significant differences were found for endoscopy duration or transfusion units.ConclusionErythromycin, particularly when combined with NG lavage, appears most effective for improving endoscopic visualization in UGIB. However, this procedural benefit did not translate into reductions in endoscopy duration or 24-h transfusion requirements, and the impact on other patient-centered outcomes remains uncertain. .

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BackgroundEmesis is a common adverse effect in cats receiving alpha-2 adrenergic agonists and opioids and may compromise perioperative welfare and safety. Comparative evidence for feline antiemetic protocols remains limited by heterogeneity in triggers, timing and outcomes.ObjectivesTo evaluate receptor-targeted antiemetic strategies in cats and quantitatively synthesise controlled event-level evidence for emesis incidence where appropriate.MethodsThis systematic review followed PRISMA 2020 principles. Controlled feline studies assessing maropitant, ondansetron or metoclopramide for prevention or treatment of emesis were eligible. The primary meta-analysis was restricted to maropitant versus control. Risk ratios (RRs) were pooled on the log scale using a random-effects model with Paule-Mandel estimation and Hartung-Knapp adjustment.ResultsFive controlled studies contributed to the primary maropitant analysis. Emesis occurred in 11/141 cats given maropitant and 70/152 controls. Maropitant reduced emesis risk (RR = 0.20, 95% confidence interval [CI]: 0.08-0.55), with low-to-moderate heterogeneity (I2 = 23.2%; Q = 5.21, p = 0.27; tau = 0.37). Leave-one-out analyses consistently favoured maropitant. The approximate prediction interval was 0.04-1.05, indicating uncertainty about the magnitude of effect in future settings. Ondansetron evidence was limited to two evidence sources and suggested possible timing-dependent benefit, whereas metoclopramide evidence was limited to one directly comparable binary study and was insufficient for pooled inference.ConclusionsMaropitant currently has the most consistent controlled evidence for reducing emesis incidence in cats under perioperative or induced-emesis conditions. Further adequately powered, blinded and randomised trials using standardised vomiting, retching and nausea outcomes are needed.

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