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Paracetamol/metoclopramide
Combination of
Paracetamol Analgesic
Metoclopramide Dopamine antagonist
Identifiers
CAS number  ?
ATC code  ?
PubChem  ?
Therapeutic considerations
Pregnancy cat.  ?
Legal status POM (UK) OTC (CH)
Routes Oral

Paracetamol/metoclopramide hydrochloride is an oral fixed dose combination prescription medication containing the analgesic paracetamol (500 mg) and the anti-emetic metoclopramide hydrochloride (5 mg). Formulated as a tablet and as sachets of a water-soluble powder, it is sold under the trade name Paramax by Sanofi-Synthelabo,[1] and in Switzerland as Migraeflux MCP[1], in Australia it is sold as Meteclomax and Anagraine.

The combination is used to treat the symptoms of migraine, both to relieve headache (the analgesic) and to treat associated nausea and vomiting (the antiemetic). In addition to its direct anti-emetic effect metoclopramide also stimulates gastric emptying (prokinetic), which is often delayed during migraine attacks, and accelerates the absorption of paracetamol.[1] However the improvement in paracetamol absorption has been questioned.[2]

The combination of metoclopramide to the paracetamol has been shown to enhance the analgesia relief when used to treat the pain of arthritis.[3]

Whilst the individual component drugs may be prescribed individually, as a combination, it is only available as the branded Paramax preparation in the UK.[4]. In the UK there are only two other combination analgesics with antiemetics (i.e., anti-nausea) products available: MigraMax (aspirin with metoclopramide) and the over-the-counter drug Migraleve (paracetamol and codeine for analgesia, with buclizine as the antiemetic).[5] The role for these products is between just the use of simple analgesics (paracetamol or ibuprofen) and the triptan class of drugs; although the latter are not options during pregnancy.[6] In the elderly although triptans are generally avoided, so too are antiemetics such as metoclopramide due to higher risks of side effects. In Australia and New Zealand, the combination is available without prescription from pharmacies. [7]

References

  1. ^ a b Electronic Medicines Compendium: Paramax Tablets, Paramax Sachets (accessed 22 April 2008)
  2. ^ Dougall JR, Cunningham B, Nimmo WS (April 1983). "Paracetamol absorption from Paramax, Panadol and Solpadeine". Br J Clin Pharmacol 15 (4): 487–9. PMID 6849786.   - Full text at PMC: 6849786
    Subsequent response from Beecham Research Laboratories:
    *Boston PF (November 1983). "Paracetamol absorption from Paramax, Panadol and Solpadeine". Br J Clin Pharmacol 16 (5): 578. PMID 6639847.   - Full text at PMC: 6639847
  3. ^ Matts SG, Boston PF (1983). "Paracetamol plus metoclopramide ('Paramax') as an adjunct analgesic in the treatment of arthritis". Curr Med Res Opin 8 (8): 547–52. PMID 6653133.  
  4. ^ "Paramax (paracetamol, metoclopramide)". NetDoctor.co.uk. 05.03.2008. http://www.netdoctor.co.uk/medicines/100002012.html. Retrieved 2008-04-22.  
  5. ^ "4.7.4.1 Treatment of acute migraine". British National Formulary (55 ed.). March 2008. pp. p.239.  
  6. ^ Pfaffenrath V, Rehm M (November 1998). "Migraine in pregnancy: what are the safest treatment options?". Drug Saf 19 (5): 383–8. PMID 9825951.  
  7. ^ Sarchielli P, Mancini ML, Calabresi P (2006). "Practical considerations for the treatment of elderly patients with migraine". Drugs Aging 23 (6): 461–89. doi:10.2165/00002512-200623060-00003. PMID 16872231.  
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