Commonly used to fight nausea and vomiting, domperidone, metoclopramide and metopimazine increase the risk of having a stroke.
- To date, no study has been published evaluating the risk of ischemic stroke associated with exposure to antidopaminergic antiemetics.
- These drugs are however used very commonly: in 2017 in France, more than 4 million people had at least one reimbursement for metopimazine.
A new French studypublished in the British Medical Journal, found an association between taking very common anti-vomiting drugs and the risk of having a stroke.
Antiemetics
Each year in France, 140,000 people are victims of a stroke. About 80% of them are cerebral infarctions, also called “ischemic stroke”, linked to the occlusion of a cerebral artery by a blood clot.
Studies have shown that the risk of ischemic stroke is increased by taking antipsychotics, drugs with antidopaminergic properties commonly prescribed in psychiatry. Researchers from Inserm, the University of Bordeaux and the Bordeaux University Hospital have therefore decided to assess this same risk with other antidopaminergic drugs: antiemetics, pills used very commonly in the symptomatic treatment of nausea. and vomiting (acute gastroenteritis, migraine, post-operative context, chemotherapy, radiotherapy).
The scientists carried out a so-called “own-control case” study using health insurance reimbursement data and hospital admissions data. In this type of study, the potential use of the drug in the period immediately preceding the accident (here 14 days) is compared with the same use during an older period (here more than a month), where it cannot have caused the event.
The trial thus initially analyzed the data of 2,612 adults hospitalized for a first ischemic stroke and having started treatment with antiemetics in the 70 days preceding the accident. In these subjects, the analyzes found a higher consumption of antiemetics in the days preceding the stroke, marked by a peak in treatment initiation over this period.
First days of use
To eliminate a bias in the results that could arise if the use of the drug varied greatly over time in the general population (for example, during epidemics of acute gastroenteritis), the research then considered, over the same period, a random group of 21,859 people who had not had a stroke. In these people, no peak or excess of use of antiemetics comparable to that highlighted in patients having presented a CVA was found.
The results of this study therefore indicate an increased risk of ischemic stroke in the first days of use of antiemetic antidopaminergic drugs. This increased risk was found for the three antiemetics studied: domperidone, metoclopramide, metopimazine.
“This initial research provides a strong signal, relating to drugs widely used in the general population. For the time being, it seems very important that these results can be replicated in other studies, which could also provide indications on the frequency of this adverse effect, which we could not measure here given the methodological approach adopted. Having precise information on the subtypes of ischemic stroke and their location would also make it possible to explore the mechanisms involved”concludes Anne Bénard-Laribière, one of the authors of the study.
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