Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial

Acad Emerg Med. 2007 Aug;14(8):715-21. doi: 10.1197/j.aem.2007.01.021. Epub 2007 May 31.

Abstract

Objectives: To compare the effects of midazolam, which is a fast and short-acting benzodiazepine, and diphenhydramine, which is a widely used anticholinergic agent, in clinical practice for the treatment of metoclopramide-induced akathisia.

Methods: All adults older than 17 years given metoclopramide for nausea and vomiting or for headache and who had akathisia were eligible for this clinical, randomized, double-blind trial. Patients were randomized to receive diphenhydramine or midazolam. Subjective, objective, and total akathisia scores and modified Ramsay Sedation Scale scores were recorded. Repeated-measures analysis of variance was used to compare the efficacy and side effects of the medications.

Results: Forty-one (73.3%) of the 56 enrolled patients were women. The mean (+/-SD) age was 39.9 (+/-15.7) years in the diphenhydramine group and 40.9 (+/-16.2) years in the midazolam group. Mean subjective, objective, and total akathisia scores in the first 5 minutes declined considerably in the midazolam group compared with the diphenhydramine group (p < 0.001). However, the mean Ramsay Sedation Scale score in the first 15 minutes increased significantly in the midazolam group compared with the diphenhydramine group (p < 0.001).

Conclusions: Midazolam can correct the symptoms of metoclopramide-induced akathisia faster than diphenhydramine, but it causes more sedation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Akathisia, Drug-Induced / drug therapy*
  • Akathisia, Drug-Induced / etiology*
  • Akathisia, Drug-Induced / physiopathology
  • Analysis of Variance
  • Diphenhydramine / administration & dosage*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Metoclopramide / adverse effects*
  • Metoclopramide / therapeutic use
  • Midazolam / administration & dosage*
  • Middle Aged
  • Probability
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Diphenhydramine
  • Metoclopramide
  • Midazolam