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Post-It Pearls: Forget prophylactic antiemetics for opioids : Emergency Medicine News


prophylactic antiemetics, IV opioids, opioid-induced vomiting


Are you administering a dose of an antiemetic drug at the same time as IV opioids? This theory seems logical given the nauseating effects that opioids have on some patients.

Three studies using metoclopramide 10 mg IV showed that this antiemetic did not reduce the need for rescue medication for vomiting. (Cochrane Database System Rev. 2022;5[5]:CD013860;

The authors concluded that a prophylactic dose of an antiemetic is not necessary for opioid-induced vomiting. Metoclopramide, however, reduced the severity of participants’ nausea compared to placebo ( MD -0.49, 95% CI -0.75 to -0.23; low-certainty evidence), but did not reduces the need for rescue medication ( RR 1.86, 95% CI 0.17 to 20.16; low-certainty evidence).

A clinical practice statement from the American Academy of Emergency Medicine made a similar recommendation and advised physicians to inquire about a history of opioid-induced vomiting or a history of motion sickness, since patients with these factors at risk may benefit from a prophylactic antiemetic. (June 7, 2019;

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Dr Linis the founder, CEO and editor of Academic Life in Emergency Medicine ( and professor of emergency medicine at the University of California, San Francisco with interests in health professions education and digital scholarship. Follow her on Instagram@MichelleLinMDand on Twitter@M_Lin.