Can some anti-nausea drugs increase stroke risk?

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A recent study found that certain anti-nausea and vomiting medications tripled the risk for ischemic stroke. The risk was highest for metopimazine, followed by metoclopramide, and then domperidone. More studies are needed to confirm the findings.

Providers may use antipsychotic medicationsTrusted Source to treat conditions such as schizophreniaTrusted Source, psychotic depressionTrusted Source, bipolar disorderTrusted Source, and dementia, which cause symptoms of psychosis or losing touch with reality. Excess dopamine may play a role in psychosis. DopamineTrusted Source is a chemical messenger or neurotransmitter that influences mood, feelings of reward, and movement. Antipsychotics Trusted Sourcework by blocking dopamine receptors in the brain, which causes a decrease in dopamine levels.

There is an associationTrusted Source between antipsychotic use and dementia in older adults and an increased risk for ischemic strokeTrusted Source or a blood clot blocking blood flow in the brain. Data from these studies led the United States Food and Drug Administration (FDA) to issue a black box warningTrusted Source to warn older people with dementia of the increased risk of death with antipsychotic use.

Other medications to treat nausea and vomiting associated with chemotherapy or migraine also block dopamine receptors or antidopaminergic antiemetics (ADA). ADAs block dopamine transmission to the intestines and the chemoreceptor trigger zoneTrusted Source in the brain, responsible for relaying signals causing vomiting. This led French-based researchers from Bordeaux University INSERM, Sorbonne Université, INSERM, and CHU de Bordeaux to evaluate if ADA use increases the risk of ischemic stroke.

Researchers examined data from 2,612 adults from the French reimbursement healthcare system database between 2012 and 2016. Participants included in the study experienced an initial ischemic stroke and received reimbursement for one or more ADA(s) within 70 days before the stroke. The researchers used reimbursements — to reflect the payment received for the treatment — as a measure of treatments administered.

The study identified 3 ADAs: domperidone, metoclopramide, and metopimazine. Domperidone and metopimazine are not approved for use to treat nausea and vomiting in the United States by the FDA. Researchers assessed the frequency of ADA for reimbursement for each participant on days 1–14 before stroke (risk period) and days 29–42, 43–56, and 57 to 70 before stroke (reference periods).

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