Drugs commonly used to treat nausea and vomiting after surgery or those caused by migraine or cancer treatment could increase the risk of ischaemic stroke, researchers warn today.
A French study in the latest edition of *The BMJ* say the three antidopaminergic antiemetics (ADAs) it studied – domperidone, metopimazine and metoclopramide – are all associated with an increased risk, especially in the first days of use.
However, the researchers from Inserm and Bordeaux University (Bordeaux Population Health Centre) and Bordeaux CHU found the highest increase was found for metopimazine and metoclopramide.
They believe the potential action of ADAs on blood flow to the brain could explain this higher risk.
For this study, the team identified 2,612 patients – average age 72 and 34% of whom were men – from the nationwide French reimbursement healthcare system database (SNDS).
All had had 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 research team compared frequencies of the ADA reimbursements between a risk period of 14 days to one day before stroke and three matched reference periods: days -70 to -57, -56 to -43, and -42 to -29 before stroke.
Patients who had had a stroke were then matched by age, sex, and stroke risk factors to a healthy control group of 21,859 randomly selected people who also received an ADA in the same time period.
It was found that among patients with stroke, 1,250 received an ADA at least once in the risk period and 1,060 in the reference periods. This compared to the control group in which 5,128 and 13,165 received an ADA at least once in the risk and reference periods, respectively.
After taking account of potentially influential factors,new users of ADA were found to be at a three-fold increased risk of stroke shortly after treatment started.
Further analysis showed men had a 3.59-fold increased risk.
The risk appeared to increase for all ADAs, the highest increase being found for metopimazine (a 3.62-fold increase) and metoclopramide (a 3.53-fold increase), both of which are drugs that cross the blood-brain barrier.
While this is an observational study, the team says its results show the risk of ischaemic stroke appears to be associated with ADA use.
Bénard-Laribière A, Hucteau E, Debette S et al. Risk of first ischaemic stroke and use of antidopaminergic antiemetics: nationwide case-time-control study. *BMJ* 24 March 2022
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