Prophylactic metoclopramide for preventing opioid-induced nausea and vomiting in cancer pain: a retrospective cohort study

Abstract

Aim: To evaluate the real-world effectiveness of prophylactic metoclopramide in preventing opioid-induced nausea and vomiting (OINV) during the initial phase of strong opioid therapy in opioid-naïve patients with cancer-related pain.

Methods: This retrospective, single-center observational cohort study included adult patients with pathologically confirmed malignancies who initiated strong opioid therapy between January 2023 and December 2024. Patients were categorized into a prophylactic metoclopramide group or a no-prophylaxis control group. Complete control (CC) of OINV during the first 7 days was defined as the absence of nausea, vomiting, and rescue antiemetic use. Univariate and multivariate logistic regression analyses were performed to identify factors associated with CC, adjusting for age, sex, body mass index, cancer subtype, cancer stage, comorbidity status, and morphine-equivalent daily dose (MEDD). Subgroup analyses were conducted based on age, sex, and cancer subtype.

Results: A total of 244 patients were included, of whom 199 received prophylactic metoclopramide, and 45 received no prophylaxis. The prophylactic group achieved significantly higher CC rates than the control group (74.9% vs. 37.8%, p < 0.001). Multivariate logistic regression confirmed that prophylactic metoclopramide was independently associated with higher odds of achieving CC (adjusted OR = 0.20, 95% CI: 0.10–0.40; p < 0.001). Similar improvements were observed for nausea and vomiting control. Subgroup analyses demonstrated consistent benefits across age and sex groups, with particularly notable effects in patients with gastrointestinal cancers.

Conclusions: Prophylactic metoclopramide significantly improves OINV control in opioid-naïve patients with cancer-related pain during the initiation of strong opioids. These findings support the rational use of early antiemetic prophylaxis in routine clinical practice. Prospective randomized trials are warranted to validate these real-world results and assess long-term safety.

Keywords

cancer-related pain / opioid-induced nausea and vomiting / metoclopramide / antiemetic prophylaxis / retrospective cohort study

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