Drugs for preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: Network meta-analysis of randomized clinical trials and trial sequential analysis

Q3 · MEDICINE

Review

Author: Sivaramakrishnan, Gowri ; Sridharan, Kannan

BACKGROUNDDifferent categories of drugs are used to reduce the incidence of post-operative nausea and vomiting (PONV) following laparoscopic cholecystectomy (LC). This study is a network meta-analysis of randomized clinical trials with such drugs.METHODSElectronic databases were searched for appropriate randomized clinical trials evaluating drugs reducing PONV in LC. Number of patients without PONV at 24 h was the primary outcome; and incidence of nausea and/or vomiting at 6 h and 24 h, and adverse events were the secondary outcome measures. Risk of bias was evaluated for each study. Mixed treatment comparison estimates were derived by random-effects modelling. Trial sequential analysis was carried out to assess the adequacy of evidence; and surface area under cumulative ranking curve was generated to identify the best intervention in the pool. Grading of the evidence for key comparisons was done.RESULTSNinety clinical trials were included. Metoclopramide, gabapentin, dixyrazine, ondansetron, granisetron, dexamethasone, tropisetron, droperidol, droperidol/dexamethasone, droperidol/metoclopramide, granisetron/droperidol and granisetron/dexamethasone, haloperidol, dexmedetomidine, palonosetron, droperidol/ondansetron, metoclopramide/dexamethasone, haloperidol/ondansetron, haloperidol/dexamethasone, palonosetron/dexamethasone and ramosetron/dexamethasone were observed with significant benefits compared to placebo. Corticosteroid/serotonin receptor antagonists was observed with the highest probability of being the 'best' in this pool. However, the moderate quality of evidence obtained was adequate to confirm the benefits of dexamethasone and ondansetron only.CONCLUSIONThe relative effect sizes for various prophylactic anti-emetics for LC was modelled using the principles of network meta-analysis. Dexamethasone and ondansetron have the best evidence as stand-alone options and the combination is preferred in high-risk category. Caution should be exercised while interpreting the evidence as the estimates might change with head-to-head clinical trial data.

12 Apr 2011·Journal of Pharmacy and PharmacologyQ3 · MEDICINE

Effects of certain tranquillisers on the level of homovanillic acid in the corpus striatum

Q3 · MEDICINE

Article

Author: Roos, B-E

Clopenthixol, triflumethazine, perphenazine, dixyrazine, prochlorperazine, methopromazine, thioridazine, levomepromazine, isospirilene (R6109), spiroperidol (R5147), chlorprothixene, trimeprazine, prothipendyl, azacyclonol, hydroxyzine, chlorpromazine, and haloperidol increased the level of homovanillic acid in the rabbit corpus striatum; hypothermia was excluded as a causative factor.Promethazine, phenoxybenzamine, and low concentrations of prothipendyl, trimeprazine, or hydroxyzine were slightly effective or not effective at all.Further work on the possible connection between antipsychotic action and increases in homovanillic acid is in progress.

01 Jun 2008·Journal of Clinical PsychopharmacologyQ4 · MEDICINE

Maternal Use of Antipsychotics in Early Pregnancy and Delivery Outcome

Q4 · MEDICINE

Article

Author: Bengt Källén ; Margareta Reis

The effect of various antipsychotics during pregnancy has repeatedly been studied, but for most atypical antipsychotics, only little information is available. We identified from the Swedish Medical Birth Register 2908 women who had reported the use of any antipsychotic or lithium in early pregnancy and studied malformation rates with data also from the Register of Congenital Malformations and the Hospital Discharge Register. Comparisons were made with all births (n = 958,729) after adjustment for some confounders. Risks were expressed as odds ratios (ORs). Most women had used dixyrazine or prochlorperazine mainly because of nausea and vomiting in early pregnancy. Seventy-nine women had used lithium, and these outcomes are reported separately. Hence, the main analysis was restricted to 570 women (576 infants) using other antipsychotics. There was a statistically significant increase in the risk for a congenital malformation-after exclusion of some common and minor conditions, the OR was 1.52 (95% confidence interval, 1.05-2.19). Exclusion of infants exposed to anticonvulsants reduced the OR only slightly. Most of the increased risk was caused by cardiovascular defects, mainly atrium or ventricular septum defect. No certain drug specificity was found. Except for an increased risk for congenital malformations, a nearly doubling of the risk for gestational diabetes and a 40% increased risk for cesarean delivery was noted. Because there seems to be little drug specificity, it is possible that underlying pathology or unidentified confounding explains the excess risk.

100 Deals associated with Dixyrazine

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KEGG	Wiki	ATC	Drug Bank
D07865	Dixyrazine	N05AB01	DB13784

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Indication	Country/Location	Organization	Date
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