Subcutaneous Route and Pharmacology of Metoclopramide

Study Overview
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Brief Summary
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Subcutaneous (SC) route has become a standard of care of many drugs administration in palliative medicine. A preliminary study showed that, although it was widely adopted among palliative care practitioners for routinely prescribed medications, standards of proof are still lacking for many molecules. Among them, metoclopramide is a largely employed drug for nausea and vomiting treatment, particularly in palliative care and oncology. Therefore, the investigator aim to study absorption and efficacy of subcutaneous administration of metoclopramide.

Detailed Description
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In this cross-over study, each patient receives subcutaneous and intravenous metoclopramide, with a randomized order of administration. During each perfusion phases, metoclopramide is administrated with continuous flow, doses being increased every two days, first from 10 to 20 and then from 20 to 30 mg/d. In order to guarantee plasmatic balance during route change, the first dose of the second phase is extended for three days. Metoclopramide plasmatic concentration is measured at inclusion and at the end of each dose administration, with a total of 7 dosages. Principal purpose of this research is to clarify subcutaneous bioavailability of metoclopramide. For this meaning, the mean difference between all subcutaneous and intravenous concentration ratios is compared. Secondary purposes consist of: calculating metoclopramide subcutaneous bioavailability for each study dose (10, 20 and 30 mg/d); describing dose-bioavailability relation for subcutaneous metoclopramide; comparing dose-concentration relationship of intravenous and subcutaneous metoclopramide; studying local tolerance by checking all inflammatory signs surrounding injection site; evaluating clinical efficacy by comparing between the two groups the number of vomiting episodes, use of Serotonin receptor antagonists and the nausea scores on a 11-level numerical scale. Eighteen patients have to be analysed at least. For each patient not having completed the study, one more will be included in order to reach the eighteen necessary patients. Therefore, it is expected to include twenty-four patients. Included population characteristics will be described. A three-dimensional analysis with period, subject and dose is performed to determine metoclopramide absolute bioavailability. For secondary criteria, dose-concentration relation is analysed with a four-dimensional analysis; dose-bioavailability and dose-concentration relations are described by linear and log-linear regression. For principal purpose, only results of patients having completed the study are part of this aforementioned analyse.

Official Title
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Subcutaneous Route and Pharmacology of Metoclopramide

Conditions
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Nausea, Vomiting

Intervention / Treatment
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* Drug: metoclopramide intravenous


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Man or woman > 18 years Patients hospitalized at the palliative medical care unit of University Hospital Bordeaux Patient whose life expectancy is greater to 4 weeks Patients suffering from nausea the day of inclusion with a greater than or equal score to 3/10 on a numerical scale (FR) from 0 to 10 and / or have had at least one vomiting within three days prior to inclusion Patients may be infused through an IV and subcutaneous (SC) Patient can communicate verbally or in writing Patients affiliates or beneficiaries of a social security fund Patient has given his written consent Exclusion criteria Pregnant or breastfeeding women Current Treatment for severe and progressive threatening disease Treatment with oral or injectable metoclopramide within 3 days prior to inclusion Treatment with levodopa or dopamine agonists in progress Neuroleptic Processing Patient with lesion occlusive syndrome Patients at risk of gastrointestinal perforation Patient with clinical signs of gastrointestinal bleeding Parkinson's disease Patients with epilepsy not controlled by anti-seizure treatment Patients suffering from liver failure Patients with a heart rate less than 60 beats / min at baseline Patients with systolic blood pressure less than or equal to 90 mmHg at baseline History of allergy to metoclopramide History of allergy to ondansetron Previous history of tardive dyskinesia to neuroleptics or metoclopramide Previous history of pheochromocytoma Previous history of methemoglobinemia with metoclopramide History of deficit NADH-cytochrome b5 reductase Patient deprived of liberty by judicial or administrative decision Major protected by law Exclusion period Patient relative over another protocol. Exclusion criteria Pregnant woman (blood β-HCG dosage ≥ 5 IU / L) Patients with a creatinine clearance less than or equal to 60 mL / min at baseline Patient with cardiac conduction disorders on ECG Patients with electrolyte imbalance in electrolytes

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: metoclopramide subcutaneous<br>every two days, first from 10 to 20 and then from 20 to 30 mg/d | Drug: metoclopramide intravenous<br>* Administration route<br>* Other names: Primperan;|
| Active Comparator: metoclopramide intravenous<br>first from 10 to 20 and then from 20 to 30 mg/d | Drug: metoclopramide intravenous<br>* Administration route<br>* Other names: Primperan;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Absolute bioavailability of SubCutaneus administration metoclopramide | Calculated by the average ratio of plasma concentrations between SC route and IV on all doses of the study (10, 20 and 30 mg / d) | 13 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Absolute bioavailability of metoclopramide subcutaneously at each dose of the study (10, 20 and 30 mg / d) | Calculated by the ratio of plasma concentrations between SC route and the IV route; | 13 days | 
| Dose-bioavailability of metoclopramide for the SC route |  | 13 days | 
| Relations plasma concentration-dose metoclopramide subcutaneously and intravenously | Measured through their apparent clearances | 13 days | 
| Cutaneous inflammatory signs and subcutaneous at the puncture site |  | During 13 days | 
| Numeric scale ranging from 0 to 10 for nausea |  | During 13 days | 
| Number of vomiting in the dose level; |  | During 13 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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metoclopramide, subcutaneous route, palliative care, pharmacology, bioavailability, nausea, vomiting