Metopimazine

Metopimazine

PEP Topic 
Chemotherapy-Induced Nausea and Vomiting—Adult
Description 

Metopimazine is a dopamine receptor antagonist that has been used for the prevention and treatment of nausea and vomiting.

Effectiveness Not Established

Research Evidence Summaries

Herrstedt, J., Sigsgaard, T.C., Nielsen, H.A., Handberg, J., Langer, S.W., Ottesen, S. & Dombernowsky, P. (2007). Randomized, double-blind trial comparing the antiemetic effect of tropisetron plys metopimazine with tropisetron plys placebo in patients receiving multiple cycles of multiple-day cisplatin-based chemotherapy. Supportive Care in Cancer, 15, 417-426.

doi: 10.1007%2Fs00520-006-0158-y
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Study Purpose:

To compare tropisetron plus metopimazine versus tropisetron plus placebo for the prevention of chemotherapy-induced nausea and vomiting (CINV)

Sample Characteristics:

This study reported on 82 patients with germ cell tumors scheduled to receive four cycles of cisplatin, given as a five-day treatment every three weeks.

Study Design:

This was a randomized, double-blind trial.

Measurement Instruments/Methods:

Patients used diaries to record the number of vomiting and retching episodes, nausea severity (on a four-point Likert-type scale), and appetite evaluation (on a four-point Likert-type scale).

Satisfaction with antiemetic treatment was collected via a categorical question (satisfied versus not satisfied). Those who were not satisfied with the antiemetic treatment were withdrawn from the study, as they were requesting additional or other treatments.

Results:

Tropisetron plus metopimazine was reported to be superior to tropisetron plus placebo in the overall period (days 1-9) in terms of complete protection from vomiting as well as decreased nausea. The treatment arm also was superior over multiple cycles, providing cumulative emetic protection.

Nursing Implications:

This study addressed an appropriate and effective antiemetic prophylaxis for multiple-day chemotherapy regimens (usually cisplatin-based). However, antiemetic control in both treatment arms was poor.

Since this study was conducted, newer agents (i.e., palonosetron and aprepitant) have been proven to have greater efficacy than the treatments used in this study. Furthermore, the treatments described in this study are known to be inferior to treatments that include a corticosteroid. Finally, the rates of protection from CINV associated with the agents studied are not good.

Khamales, S., Bethune-Volters, A., Chidiac, J., Bensaoula, O., Delgado, A., & Di Palma, M.. (2006). A randomized, double-blind trial assessing the efficacy and safety of sublingualmetopimazine and ondansetron in the prophylaxis of chemotherapy-induced delayedemesis. Anticancer Drugs, 17(2), 217-224.

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Study Purpose:

To compare the efficacy and safety of sublingual metopimazine to ondansetron orally disintegrating tablet (ODT) in patients receiving highly emetogenic chemotherapy (HEC) for the prevention of delayed (not acute) chemotherapy-induced nausea and vomiting (CINV)

Intervention Characteristics/Basic Study Process:

Participants were randomized to one of two treatment arms. In group 1, patients received 7.5 mg sublingual metopimazine every eight hours on days 2–6, and, in group 2, patients received ODT ondansetron on days 2–6.

Sample Characteristics:

  • The study consisted of 210 participants.
  • The sublingual metopimazine group had 103 patients, and the ODT ondansetron group had 97 patients.

Measurement Instruments/Methods:

  • Patients recorded symptoms in daily diaries.
  • The Functional Living Index–Emesis (FLIE) was used.

Results:

No significant differences were found between the two groups in control of delayed CINV, quality of life (QOL), or safety; however, control of delayed CINV was inferior compared to other studies.

Limitations:

  • This study evaluated an “old” regimen that has since been considered suboptimal care per current consensus guidelines because of availability of newer, superior agents.
  • Corticosteroids were not allowed in the study.
  • The overall dose of metopimazine was low (ineffective).

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