Three drugs commonly used to relieve nausea and vomiting are associated with an increased risk of ischemic stroke, according to new research.
The findings are published in the BMJ.
Antidopaminergic antiemetics (ADAs) domperidone, metopimazine and metoclopramide were associated with an increased risk, especially in the first days of use.
The drugs are often used in cases of migraine, chemotherapy, radiotherapy and after surgery.
The researchers suggest that the higher risk could be attributed to the potential action of ADAs on blood flow to the brain.
The team analysed 2,612 patients in France with a first ischaemic stroke between 2012 and 2016 and at least one reimbursement for domperidone, metopimazine or metoclopramide in the 70 days before their stroke.
The patients had an average age of 72 and 34 per cent were men.
They then compared the frequencies of these ADA reimbursements between a risk period of days -14 to -1 before stroke and three matched reference periods of days -70 to -57, -56 to -43, and -42 to -29 before stroke.
The stroke patients were matched by age, sex and stroke risk factors to a healthy control group who received an ADA in the same time period.
A total of 1,250 stroke patients received an ADA at least once in the risk period and 1,060 in the reference periods.
Among the control group, 5,128 and 13,165 received an ADA at least once in the risk and reference periods.
After accounting for risk factors, new users of ADA were found to have up to a three times greater risk of stroke shortly after treatment started.
Further analyses by age, sex, and history of dementia showed similar results, with men facing the highest risk.
The greatest risk increase was found in metopimazine (a 3.62-fold increase) and metoclopramide (a 3.53-fold increase) – both drugs cross the blood-brain barrier.
The researchers wrote:
“[The] higher risk found for drugs crossing the blood-brain barrier suggests a potential central effect, possibly through an action on cerebral blood flow.
“Our results show that the risk of ischaemic stroke appears to be associated with ADA use.
“However, further causal inference research is needed to confirm this association in other settings, and to integrate ischaemic stroke subtype information in the analyses to help determine the extent of the risk increase that can be attributed to ADAs.”
