Nausea Clinical Trial
Official title:
Subcutaneous Route and Pharmacology of Metoclopramide
Subcutaneous (SC) route has become a standard of care of many drugs administration in palliative medicine. A preliminary study showed that, although it was widely adopted among palliative care practitioners for routinely prescribed medications, standards of proof are still lacking for many molecules. Among them, metoclopramide is a largely employed drug for nausea and vomiting treatment, particularly in palliative care and oncology. Therefore, the investigator aim to study absorption and efficacy of subcutaneous administration of metoclopramide.
In this cross-over study, each patient receives subcutaneous and intravenous metoclopramide,
with a randomized order of administration. During each perfusion phases, metoclopramide is
administrated with continuous flow, doses being increased every two days, first from 10 to 20
and then from 20 to 30 mg/d. In order to guarantee plasmatic balance during route change, the
first dose of the second phase is extended for three days. Metoclopramide plasmatic
concentration is measured at inclusion and at the end of each dose administration, with a
total of 7 dosages.
Principal purpose of this research is to clarify subcutaneous bioavailability of
metoclopramide. For this meaning, the mean difference between all subcutaneous and
intravenous concentration ratios is compared. Secondary purposes consist of: calculating
metoclopramide subcutaneous bioavailability for each study dose (10, 20 and 30 mg/d);
describing dose-bioavailability relation for subcutaneous metoclopramide; comparing
dose-concentration relationship of intravenous and subcutaneous metoclopramide; studying
local tolerance by checking all inflammatory signs surrounding injection site; evaluating
clinical efficacy by comparing between the two groups the number of vomiting episodes, use of
Serotonin receptor antagonists and the nausea scores on a 11-level numerical scale.
Eighteen patients have to be analysed at least. For each patient not having completed the
study, one more will be included in order to reach the eighteen necessary patients.
Therefore, it is expected to include twenty-four patients. Included population
characteristics will be described. A three-dimensional analysis with period, subject and dose
is performed to determine metoclopramide absolute bioavailability. For secondary criteria,
dose-concentration relation is analysed with a four-dimensional analysis;
dose-bioavailability and dose-concentration relations are described by linear and log-linear
regression. For principal purpose, only results of patients having completed the study are
part of this aforementioned analyse.
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