Can some anti-nausea drugs put you at risk for a stroke?

Antipsychotic drugs may be used to treat illnesses like schizophrenia, psychotic depression, bipolar disorder, and dementia, which all cause symptoms of psychosis or loss of touch with reality. Psychosis may be caused by too much dopamine.

Dopamine is a neurotransmitter that affects emotion, reward, and movement. Antipsychotics reduce dopamine levels by inhibiting dopamine receptors in the brain.

Antipsychotic stroke risk

Antipsychotic usage has been linked to dementia in older adults, as well as an increased risk of ischemic stroke, or a blood clot obstructing blood flow to the brain. The United States Food and Drug Administration (FDA) issued a black box warning based on the findings of this research, advising older adults with dementia about the increased risk of death associated with antipsychotic treatment.

Antidopaminergic antiemetics or other drugs that block dopamine receptors are used to treat nausea and vomiting caused by chemotherapy or migraines (ADA). ADAs stop dopamine from reaching the intestines and the brain’s chemoreceptor trigger zone, which is in charge of transmitting signals that cause vomiting.

This encouraged Bordeaux University INSERM, Sorbonne Université, INSERM, and CHU de Bordeaux researchers to investigate if ADA usage increased the risk of ischemic stroke. They published their findings in The BMJ.

Between 2012 and 2016, researchers examined data from 2,612 individuals in the French reimbursed healthcare system database. The study’s participants had a first ischemic stroke and obtained reimbursement for one or more ADA(s) within 70 days of the incident.

As a measure of treatments provided, the researchers used reimbursements, which represent the amount received for the treatment.

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.

The frequency of ADA for reimbursement was examined for each participant on days 1–14 before stroke (risk period) and days 29–42, 43–56, and 57–70 before stroke (recovery period).

The data of the participants were compared to that of a control group of 21,859 people who had not had an ischemic stroke. Participants in the experiment were matched by age, sex, and ischemic stroke risk factors to participants in the control group.

The average age of the study participants was 71.9 years old, with almost one-third of them being men. Approximately 97 percent of people who suffered an ischemic stroke were given an ADA drug.


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