Metoclopramide migraine

NSAIDs are contraindicated after 37 weeks gestation. For refractory migraines, narcotics may be used. Salicylates and indomethacin should be avoided throughout pregnancy if possible. The use of sumatriptan is controversial. Nausea of migraines may be treated with metoclopramide. 

Uses. Metoclopramide is used for nausea and vomiting associated with gastrointestinal disorders, and with cytotoxic drugs and radiotherapy. It is also an effective antiemetic in migraine and is used as a prokinetic agent (see above). 

Metoclopramide Aspirin Increased rate and extent of absorption of aspirin in patients with migraine Can be used therapeutically... 

Rectal metoclopramide 20 mg, given to 8 healthy subjects 30 minutes before oral tolfenamie aeid 300 mg, eaused a threefold increase in the serum tolfenamie aeid levels at 45 minutes. There was no change in the maximum level or the AUC. In another study, rectal metoclopramide similarly enhanced the rate of oral absorption of tolfenamic acid when given during a migraine attack. ... 

The clinical importance of the reduction in ketoprofen levels is unknown, but the authors of the study recommend that ketoprofen (and possibly other NSAIDs that are poorly soluble) should be t en 1 to 2 hours before metoclopramide. Conversely, for aspirin, tolfenamic acid, and other NSAIDs, metoclopramide can be used to increase the rate of absorption, and therefore possibly speed up the onset of analgesic effect in conditions such as migraine. 

Volans GN. The effect of metoclopramide on the absoipticn of effervescent aspirin in migraine. BrJ Clin Pharmacol 91S) 2,57-63. 

Ross-Lee LM, Eadie MJ, Heazlewood V, Bodmer F, Tyrer JH. A irin pharmacokinetics in migraine the effect of metoclopramide. EurJCtin Pharmacol (19S3 ) 24,777-85. 

Tfelt-Hansen P, Olesen J. Effervescent metoclopramide and aspirin (Migravess) versus effervescent aspirin or placebo for migraine attacks a double-blind shufy. Cephalalgia (1984) 4, 107-11... 

Intravenous metoclopramide 10 mg increased the peak plasma levels of a single 1.5-g dose of paracetamol by 64% in 5 healthy subjects (slow absorbers of paracetamol), and increased its rate of absorption (peak levels reached in 48 minutes instead of 120 minutes), but the total amount absorbed remained virtually unaltered. Oral metoclopramide also increases the rate of paracetamol absorption, probably because the rate of gastric emptying is increased. Similarly, the speed of absorption of paracetamol may also be increased by domperidone. This interaction is exploited in Paramax (a proprietary oral preparation containing both paracetamol and metoclopramide) to increase the effectiveness and onset of analgesia for the treatment of migraine. This is obviously an advantageous interaction in this situation. 

Seaber EJ, Ridout G, Layton G, Posner J, Peck RW. The novel anti-migraine zolmitriptan (Zomig 311C90) has no clinically significant interactions with paracetamol or metoclopramide. EurJ Clin Pharmacol (1997) 53,229-34. 

Migraine headaches accompanied with nausea and vomiting can be controlled by starting with a prokinetic such as metoclopramide or domperidone in a suppository, followed by an analgesic in a second suppository. 

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