Widely used anti-nausea drugs raise risk for ischemic stroke, study finds

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Anti-nausea and vomiting medication may increase the risk for a common type of stroke, according to a new study. File Photo by Staff Sgt. Jonathon Fowler/U.S. Air Force

0A class of commonly used drugs designed to relieve nausea and vomiting has been linked with an increased risk for ischemic stroke, a study published Wednesday by the BMJ found.

Patients on antidopaminergic antiemetics, which are typically used to relieve nausea and vomiting caused by migraine, chemotherapy or radiotherapy for cancer, as well as surgery, had a more than three-fold higher risk for ischemic stroke than those not on the drugs, the data showed.

Ischemic stroke is the most common type of stroke, and it is caused by clots that block blood vessels in the brain, keeping blood from flowing to the brain, according to the National Library of Medicine.

All three antidopaminergic antiemetics included in the analysis — domperidone, metopimazine and metoclopramide — increased the risk for ischemic stroke among users, particularly after early doses, the researchers said.

However, metopimazine and metoclopramide were associated with the highest risk for ischemic stroke among the three drugs, they said.

The action of antidopaminergic antiemetics on blood flow to the brain could explain this higher risk, according to the researchers.

“The study we performed raises a strong signal associating the use of antiemetics to an increased risk of ischemic stroke,” study co-author Antoine Pariente told UPI in an email.

“This is not the first adverse effects identified for these drugs, and potentially not even the most serious one, [but] this will need to be considered by prescribers,” said Pariente, director of the pharmaco-epidemiology team at the Bordeaux Population Health Center in France.

Like antipsychotics used to treat mental illness, these antiemetics, or anti-nausea and vomiting drugs are antidopaminergic, meaning they work by blocking dopamine activity in the brain, he and his colleagues said.

Antipsychotics also have been associated with an increased risk of ischemic stroke in earlier studies.

For this study, Pariente and his colleagues identified 2,612 patients who suffered their first ischemic stroke between 2012 and 2016 and had received at least one prescription for domperidone, metopimazine or metoclopramide 70 days or fewer before their stroke.

Patients were an average age of 72 years and 34% were men, the researchers said.

They compared the incidence of ischemic stroke among these patients with that among a healthy control group of 21,859 randomly selected people who received an antidopaminergic antiemetic drug during the same time period, they said.

Among patients who suffered an ischemic stroke, 1,250, or 48%, received an antidopaminergic antiemetic drug at least once within 14 days before their stroke, the data showed.

Men were found to be at the highest risk for ischemic stroke following antidopaminergic antiemetic use, with a 3.6-fold increased risk, the researchers said.

Users of metopimazine also had a 3.6-fold higher risk for ischemic stroke, while those taking metoclopramide had a 3.5-fold higher risk, according to the researchers.

“All drugs convey some health risks or risk of adverse effects,” Pariente said.

“As always and for all drugs, the best way to reduce harm is a rational use of the drugs, in situations in which they are most likely to benefit to patient and less likely to harm,” he said.


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