Clinical Question: Which antiemetic is more effective for moderate to severe nausea: droperidol (Inapsine), metoclopramide (Reglan), or prochlorperazine (Compazine)?

Setting: Emergency department

Study Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: A total of 97 patients with moderate to severe nausea (score of at least 40 on a 100-point visual analog scale) were randomly assigned to receive 1.25 mg droperidol, 10 mg metoclopramide, 10 mg prochlorperazine, or saline placebo. After 30 minutes, the research team reassessed the patients’ nausea using the same visual analog scale. They also assessed sedation and anxiety, asked whether the patients needed more medication, assessed each patient’s satisfaction with the treatment, and evaluated side effects. Each assessment was performed by a staff member unaware of which treatment the patient received. Analysis was by intention to treat.

All treatments, including saline, reduced the severity of nausea in a clinically significant manner. Similar reductions occurred in anxiety. There was no significant sedation with any of the treatments. However, when comparing the change in nausea scores, droperidol was 15 points more effective in reducing nausea from baseline at 30 minutes than any of the other agents. On a 100-point scale, this is a clinically important difference. Droperidol also was more noxious, causing akathisia in 71 percent of patients at the 24-hour follow-up interview compared with 23 percent of patients treated with any of the other medications (number needed to harm = 2.1; 95% confidence interval, 1.5 to 5.3).

Bottom Line: Although droperidol is significantly better at reducing the severity of nausea than metoclopramide or prochlorperazine, it causes significantly more akathisia. (Level of Evidence: 1b–)