㈼−2- 11 |
急性期治療において制吐薬の使用は有用か |
論文抄録 |
STUDY OBJECTIVES: By evaluating the efficacy of metoclopramide alone and in combination with ibuprofen versus placebos, this study was designed to both evaluate the efficacy of metoclopramide and elucidate its mechanism of action in the treatment of migraine headache. DESIGN: The study was conducted over a two-year period and was a randomized, double-blind, placebo-controlled study. SETTING: An urban teaching hospital. PARTICIPANTS: Patients enrolled were at least 18 years old and had recurring headaches with one or more of the following characteristics: unilateral, preceded by neurologic symptoms, significant nausea and vomiting, or mood changes and photophobia. INTERVENTION: Ten milligrams of metoclopramide or an equal volume of IV normal saline was given and 600 mg of ibuprofen or identical-appearing placebo was given orally at time 0. Patients rated their pain and nausea at time 0, 30 minutes, and 60 minutes using visual-analog scales. RESULTS: The differences in pain and nausea scores for the metoclopramide + placebos group versus the other three groups were tested using exact nonparametric (Mann-Whitney) statistical procedures. The metoclopramide + placebos group had significantly better relief of pain compared with the placebos + ibuprofen and placebos + placebos groups. The metoclopramide + placebos group had significantly better relief of nausea than the ibuprofen + placebos group; nausea scores for the placebos + placebos group could not be analyzed due to excessive variance from the other groups at baseline. The differences between the metoclopramide + placebos group and the metoclopramide + ibuprofen group were not statistically significant with regard to either pain or nausea. CONCLUSION: Metoclopramide is efficacious in the treatment of both the pain and nausea of migraine headache. This is a direct action that is not dependent on the concomitant administration of another agent. |
文献 PubMed−ID |
PMID: 8427430 |
エビデンスレベル |
Ib |
文献タイトル (日本語) |
片頭痛治療におけるメトクロプラミドの効果 |
目的 |
制吐剤メトクロプラミド単独と鎮痛剤 イブプロフェンとの合剤の片頭痛治療効果を評価 |
研究デザイン |
a randomized, double-blind, placebo-controlled study |
研究施設 |
An urban teaching hospital |
研究期間 |
2年間 |
対象患者 |
18 歳以上の片頭痛患者 40 人. |
介入 |
片頭痛急性期に Group1 メトクロプラミド 10mg 静注 + イブプロフェン 600 mg内服 Group2 メトクロプラミド 10mg 静注 + プラセボ内服 Group3 プラセボ静注 + イブプロフェン 600 mg内服 Group4 プラセボ静注 + プラセボ内服 |
主要評価項目とそれに用いた 統計学的手法 |
頭痛の程度,嘔気を投与時・ 30 分後・ 60 分後に記録 |
結果 |
頭痛の程度・嘔気とも Group2 (メトクロプラミド + プラセボ)は Group3 (プラセボ + イブプロフェン), Group4 (プラセボ + プラセボ)よりも有意に改善した. Group3 (プラセボ + イブプロフェン)とは効果に差がみられなかった. |
結論 |
メトクロプラミド 10mg 静注単独投与は片頭痛の程度・嘔気双方に有効であった. |
備考 |
Publication Types:
・ Clinical Trial ・Randomized Controlled Trial MeSH Terms: |
作成者 |
井尻珠美 |
10) MacGregor EA, Wilkinson M, Bancroft K . Domperidone plus |
|
論文抄録 |
This study was designed to evaluate the safety and efficacy of domperidone in combination with paracetamol in the treatment of migraine. Severity of headache, duration of migraine attack and overall efficacy of treatment were amongst the variables assessed in a randomized, double-blind, three-way cross-over comparison of 1 g paracetamol plus either domperidone 30 mg, domperidone 20 mg or placebo, taken at onset of headache. Forty-six patients attending the City of London Migraine Clinic completed the study. A significant difference was observed in the duration of the migraine attack: a median of 17.5 h with paracetamol alone was reduced to 12.0 h with the addition of domperidone 20 mg, and to 12.0 h with domperidone 30 mg. No significant adverse events were reported. A reduction in pain intensity and nausea was noted but this was not statistically significant. It was concluded that domperidone shortens the duration of a migraine attack and may help reduce headache and associated symptoms |
文献 PubMed−ID |
PMID: 8495454 |
エビデンスレベル |
Ib |
文献タイトル (日本語) |
片頭痛治療におけるドンペリドン+ アセトアミノフェン |
目的 |
制吐剤ドンペリドンと鎮痛剤 アセトアミノフェン の併用が片頭痛治療薬として効果的かつ安全かどうか決定すること. |
研究デザイン |
無作為二重盲検三元交差比較試験( randomized, double-blind, three-way cross-over comparison ) |
研究施設 |
ロンドン 片頭痛クリニック ( the City of London Migraine Clinic ) |
対象患者 |
18 歳〜 70 歳の片頭痛患者 50 人. |
介入 |
片頭痛急性期にアセトアミノフェン 1g にドンペリドン 30mg or ドンペリドン 20mg or プラセボを併用. |
主要評価項目とそれに用いた統計学的手法 |
頭痛の程度,頭痛持続時間 |
結果 |
ドンペリドン併用にてプラセボ併用と比較し持続時間の有意な短縮がみられた ( ドンペリドン 30mg p=0.019 ,ドンペリドン 20mg p=0.001) . 悪心の減少がみられたが有意ではなかった. 有害事象は 4 人のみにみられ,重篤なものはなかった. |
結論 |
アセトアミノフェンにドンペリドンを併用することで片頭痛急性期の治療効果が上がると考えられた. |
コメント |
比較的うまくデザインされた中規模の RCT. レポートの質は高い. |
備考 |
Publication Types: MeSH Terms: Substances: |
作成者 |
井尻珠美,竹島多賀夫 |