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Risk for Ischemic Stroke Up With Antidopaminergic Antiemetic Use

Increase in risk greatest for metopimazine and metoclopramide; risk for ischemic stroke may be higher in first days of use

TUESDAY, March 29, 2022 (HealthDay News) — The risk for ischemic stroke is increased in association with the use of antidopaminergic antiemetics (ADAs), according to a study published online March 23 in The BMJ.

Anne Bénard-Laribière, from the University of Bordeaux in France, and colleagues conducted a case-time-control study to estimate the risk for ischemic stroke associated with ADA use. Eligible participants were aged 18 years or older with a first ischemic stroke between 2012 and 2016 and at least one reimbursement for any ADA in the 70 days prior to stroke. For each patient, the frequencies of ADA reimbursements were compared for a risk period at days −14 to −1 before stroke and three matched reference periods.

The researchers found that among the 2,612 patients with incident stroke, 1,250 and 1,060 received an ADA in the risk period and reference periods, respectively. Among 21,859 randomly selected matched controls, 5,128 and 13,165 received an ADA in the same periods, respectively, yielding a ratio of adjusted odds ratios of 3.12. Similar results were seen on stratification of analyses by age, sex, and history of dementia. For analyses stratified by ADA, the case-time-control ratio of adjusted odds ratios was 2.51, 3.62, and 3.53 for domperidone, metopimazine, and metoclopramide, respectively. In sensitivity analyses, the risk was suggested to be higher in the first days of use.

“Further causal inference research is needed to confirm this association in other settings, and to integrate ischemic stroke subtype information in the analyses to help determine the extent of the risk increase that can be attributed to ADA,” the authors write.

One author disclosed financial ties to Roche and Pfizer.

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