Successful administration of metoclopramide for the treatment of nausea in patients with advanced liver disease

A double-blind comparison of metocloprumide \Tersus placebo was performed on 8 cirrhotic putients with nausea (8 cases) and heartburn (3 of the 8 cases] plus mild portal-systemic encephalopathy. As metocloprumide is a dopamine ontagonist and dopamine-inudequate neurotransmission has been implicated in the pathogenesis of hepatic comu, this study IYUS CIJS~J designed to evuluate the eflfects of metoclopramide on mentul stute. The study included basal. placebo, metoclopramide, and finul periods; each period lasted for 2 wk. Throughout the study putients received 3 g/day of neomycin and un 1800-caJ diet contuining 40 g/day of mixed protein. During the placebo cmd metocJopramide phases patients recei\.ed either two IO-mg metoclopramide capsules t.i.d. or identical placebo capsules. During the study, bitveekly liver function tests and portolsystemic encephalopathy purameters 1jrere evaluuted. A self-evaluation for the presence of nnusea und heartburn was ulso obtained. To monitor the dopumine-blockade effect of metoclopramide, serum proJactin levels rvere measured. Metoclopramide significantly suppressed the subjective signs ot’ nausea (7 of 8 cases) cmd heartburn (all cases). Serum prolactin levels were 22 t 21 ngiml, 30 t 31 nglml, 110 + 57 ng/mJ (p < 0.011, and 18.6 + 2 nglml during busal, placebo, metoclopramide, and final periods, respec-