Paracetamol/metoclopramide

Drugbox
type = combo
component1 = Paracetamol
class1 = Analgesic
component2 = Metoclopramide
class2 = Dopamine antagonist
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pregnancy_AU =
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legal_UK = POM
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legal_status = OTC (CH)
routes_of_administration = 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, [http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=6975 Electronic Medicines Compendium: Paramax Tablets, Paramax Sachets] (accessed 22 April 2008)] and in Switzerland as Migraeflux MCP [http://www.migraeflux.org/] .

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. However the improvement in paracetamol absorption has been questioned.cite journal |author=Dougall JR, Cunningham B, Nimmo WS |title=Paracetamol absorption from Paramax, Panadol and Solpadeine |journal=Br J Clin Pharmacol |volume=15 |issue=4 |pages=487–9 |year=1983 |month=April |pmid=6849786 |doi= |url= - PMC|6849786
Subsequent response from Beecham Research Laboratories: *cite journal |author=Boston PF |title=Paracetamol absorption from Paramax, Panadol and Solpadeine |journal=Br J Clin Pharmacol |volume=16 |issue=5 |pages=578 |year=1983 |month=November |pmid=6639847 |doi= |url= - PMC|6639847]

The combination of metoclopramide to the paracetamol has been shown to enhance the analgesia relief when used to treat the pain of arthritis.cite journal |author=Matts SG, Boston PF |title=Paracetamol plus metoclopramide ('Paramax') as an adjunct analgesic in the treatment of arthritis |journal=Curr Med Res Opin |volume=8 |issue=8 |pages=547–52 |year=1983 |pmid=6653133 |doi= |url=]

Whilst the individual component drugs may be prescribed individually, as a combination, it is only available as the branded Paramax preparation in the UK. [cite web |title=Paramax (paracetamol, metoclopramide) |url=http://www.netdoctor.co.uk/medicines/100002012.html |date=05.03.2008 |publisher=NetDoctor.co.uk |accessdate=2008-04-22] . 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). [cite book |title=British National Formulary |edition=55 |date=March 2008 |chapter=4.7.4.1 Treatment of acute migraine |pages=p.239] 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.cite journal |author=Pfaffenrath V, Rehm M |title=Migraine in pregnancy: what are the safest treatment options? |journal=Drug Saf |volume=19 |issue=5 |pages=383–8 |year=1998 |month=November |pmid=9825951 |doi= |url=] In the elderly although triptans are generally avoided, so too are antiemetics such as metoclopramide due to higher risks of side effects.cite journal |author=Sarchielli P, Mancini ML, Calabresi P |title=Practical considerations for the treatment of elderly patients with migraine |journal=Drugs Aging |volume=23 |issue=6 |pages=461–89 |year=2006 |pmid=16872231 |doi= |url=]

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