PROCHLORPERAZINE
VERSUS PROMETHAZINE FOR UNCOMPLICATED NAUSEA AND VOMITING IN THE EMERGENCY
DEPARTMENT: A RANDOMIZED, DOUBLE-BLIND CLINICAL TRIAL.
Ernst
AA, et al. Ann Emerg Med 2000 Aug;36(2):89-94.
STUDY
OBJECTIVE: Nausea and vomiting related to gastritis or gastroenteritis are
common complaints in the emergency department. The most effective antiemetic
agent is yet undetermined. This study was conducted to compare the efficacy of
prochlorperazine versus promethazine for uncomplicated nausea and vomiting in
the ED.
METHODS:
The study was a randomized, double-blind comparison of prochlorperazine
(Compazine) and promethazine (Phenergan) for acute ED treatment of gastritis or
gastroenteritis. We studied patients 18 years or older with presumed uncomplicated
gastritis or gastroenteritis who presented to 2 academic EDs. Patients were
randomly assigned to receive either prochlorperazine, 10 mg intravenously, or
promethazine, 25 mg intravenously. Visual analog scale readings of patient
comfort were obtained at baseline and at 30- and 60-minute intervals. The
primary endpoint was degree of relief at 30 and 60 minutes. Secondary endpoints
were time to complete relief, need for further antiemetic medication (treatment
failures), and side effects. Statistical analysis was performed using the
Mann-Whitney U test for nonparametric analysis and repeated-measures analysis
of variance (ANOVA).
RESULTS:
Eighty-four patients were enrolled in the study; 42 received prochlorperazine
and 42 received promethazine. There were no differences in demographics in the
2 groups. At baseline (time 0), there was no difference in symptoms (P =.23).
At 30 and 60 minutes after receiving medication, prochlorperazine worked
significantly better than promethazine (P =.004 and P <.001 using
nonparametric analysis). Using repeated-measures ANOVA, there was a significant
difference in symptoms over time for both groups (P <.001) and a significant
difference in prochlorperazine versus promethazine (P =.002). Time to complete
relief was significantly shorter with prochlorperazine (P =.021). There were
significantly fewer treatment failures with prochlorperazine (P =.03, 9.5%
versus 31%; difference 21%, 95% confidence interval 5 to 38). There was no
difference in incidence of extrapyramidal effects. Prochlorperazine caused
significantly fewer complaints of sleepiness (P =.002, 38% versus 71%;
difference 33%, 95% confidence interval 13 to 53; P =.002).
CONCLUSION:
Prochlorperazine works significantly better than promethazine for relieving symptoms
of nausea and vomiting more quickly and completely in ED patients with
uncomplicated nausea and vomiting.