Paracetamol/metoclopramide

Paracetamol/metoclopramide
Combination of
Paracetamol	Analgesic
Metoclopramide	Dopamine antagonist
Clinical data
Routes of; administration	Oral
Legal status
Legal status	AU: S3 (Pharmacist only); UK: POM (Prescription only); OTC (CH);
Identifiers
CAS Number	73802-00-3 ;
	(verify)

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,^[1] and in Switzerland as Migraeflux MCP,^[2] in Australia it is sold as Meteclomax and Anagraine.

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.^[1] However the improvement in paracetamol absorption has been questioned.^[3]

The combination of metoclopramide to the paracetamol has been shown to enhance the analgesia relief when used to treat the pain of arthritis.^[4]

Whilst the individual component drugs may be prescribed individually, as a combination, it is only available as the branded Paramax preparation in the UK.^[5] 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).^[6] 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.^[7] In the elderly although triptans are generally avoided, so too are antiemetics such as metoclopramide due to higher risks of side effects. In Australia and New Zealand, the combination is available without prescription from pharmacies.^[8]

References

^ ^a ^b Electronic Medicines Compendium: Paramax Tablets, Paramax Sachets (accessed 22 April 2008)
^ [1]
^ Dougall JR, Cunningham B, Nimmo WS (April 1983). "Paracetamol absorption from Paramax, Panadol and Solpadeine". Br J Clin Pharmacol. 15 (4): 487–9. doi:10.1111/j.1365-2125.1983.tb01534.x. PMC 1427806. PMID 6849786.
Subsequent response from Beecham Research Laboratories:
*Boston PF (November 1983). "Paracetamol absorption from Paramax, Panadol and Solpadeine". Br J Clin Pharmacol. 16 (5): 578. doi:10.1111/j.1365-2125.1983.tb02223.x. PMC 1428077. PMID 6639847.
^ Matts SG, Boston PF (1983). "Paracetamol plus metoclopramide ('Paramax') as an adjunct analgesic in the treatment of arthritis". Curr Med Res Opin. 8 (8): 547–52. doi:10.1185/03007998309109796. PMID 6653133.
^ "Paramax (paracetamol, metoclopramide)". NetDoctor.co.uk. June 2, 2017 [2008]. Retrieved 2008-04-22.
^ "4.7.4.1 Treatment of acute migraine". British National Formulary (55th ed.). March 2008. p. 239.
^ Pfaffenrath V, Rehm M (November 1998). "Migraine in pregnancy: what are the safest treatment options?". Drug Saf. 19 (5): 383–8. doi:10.2165/00002018-199819050-00005. PMID 9825951. S2CID 21807755.
^ Sarchielli P, Mancini ML, Calabresi P (2006). "Practical considerations for the treatment of elderly patients with migraine". Drugs Aging. 23 (6): 461–89. doi:10.2165/00002512-200623060-00003. PMID 16872231. S2CID 8746056.

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[emc-1] Electronic Medicines Compendium: Paramax Tablets, Paramax Sachets (accessed 22 April 2008)

[2] [1]

[pmid6849786-3] Dougall JR, Cunningham B, Nimmo WS (April 1983). "Paracetamol absorption from Paramax, Panadol and Solpadeine". Br J Clin Pharmacol. 15 (4): 487–9. doi:10.1111/j.1365-2125.1983.tb01534.x. PMC 1427806. PMID 6849786.
Subsequent response from Beecham Research Laboratories:
*Boston PF (November 1983). "Paracetamol absorption from Paramax, Panadol and Solpadeine". Br J Clin Pharmacol. 16 (5): 578. doi:10.1111/j.1365-2125.1983.tb02223.x. PMC 1428077. PMID 6639847.

[pmid6653133-4] Matts SG, Boston PF (1983). "Paracetamol plus metoclopramide ('Paramax') as an adjunct analgesic in the treatment of arthritis". Curr Med Res Opin. 8 (8): 547–52. doi:10.1185/03007998309109796. PMID 6653133.

[5] "Paramax (paracetamol, metoclopramide)". NetDoctor.co.uk. June 2, 2017 [2008]. Retrieved 2008-04-22.

[6] "4.7.4.1 Treatment of acute migraine". British National Formulary (55th ed.). March 2008. p. 239.

[pmid9825951-7] Pfaffenrath V, Rehm M (November 1998). "Migraine in pregnancy: what are the safest treatment options?". Drug Saf. 19 (5): 383–8. doi:10.2165/00002018-199819050-00005. PMID 9825951. S2CID 21807755.

[pmid16872231-8] Sarchielli P, Mancini ML, Calabresi P (2006). "Practical considerations for the treatment of elderly patients with migraine". Drugs Aging. 23 (6): 461–89. doi:10.2165/00002512-200623060-00003. PMID 16872231. S2CID 8746056.

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v t e Non-steroidal anti-inflammatory drugs (NSAIDs) (primarily M01A and M02A, also N02BA)
pyrazolones / pyrazolidines	Aminophenazone Ampyrone Azapropazone Clofezone Difenamizole Famprofazone Feprazone Kebuzone Metamizole Mofebutazone Morazone Nifenazone Oxyphenbutazone Phenazone Phenylbutazone Propyphenazone Sulfinpyrazone Suxibuzone^‡
salicylates	Aspirin (acetylsalicylic acid)^# Aloxiprin Benorylate Carbasalate calcium Diflunisal Dipyrocetyl Ethenzamide Guacetisal Magnesium salicylate Methyl salicylate Salsalate Salicin Salicylamide Salicylic acid (salicylate) Sodium salicylate
acetic acid derivatives and related substances	Aceclofenac Acemetacin Alclofenac Amfenac Bendazac Bromfenac Bufexamac Bumadizone Diclofenac Difenpiramide Etodolac Felbinac Fenclozic acid Fentiazac Indometacin Indometacin farnesil Isoxepac Ketorolac Lonazolac Mofezolac Oxametacin Prodolic acid Proglumetacin Sulindac Tiopinac Tolmetin Zomepirac^†
oxicams	Ampiroxicam Droxicam Isoxicam Lornoxicam Meloxicam Piroxicam Pivoxicam Tenoxicam
propionic acid derivatives (profens)	Alminoprofen Benoxaprofen^† Carprofen^‡ Dexibuprofen Dexketoprofen Fenbufen Fenoprofen Flunoxaprofen Flurbiprofen Ibuprofen^# Ibuproxam Indoprofen^† Ketoprofen Loxoprofen Miroprofen Naproxen Oxaprozin Pelubiprofen Piketoprofen Pirprofen Suprofen Tarenflurbil Tepoxalin^‡ Tiaprofenic acid Vedaprofen^‡ Zaltoprofen COX-inhibiting nitric oxide donator: Naproxcinod
n-arylanthranilic acids (fenamates)	Azapropazone Clonixin Etofenamate Floctafenine Flufenamic acid Flunixin Flutiazin Glafenine^† Meclofenamic acid Mefenamic acid Morniflumate Niflumic acid Tolfenamic acid
COX-2 inhibitors (coxibs)	Apricoxib Celecoxib (+tramadol) Cimicoxib^‡ Deracoxib^‡ Etoricoxib Firocoxib^‡ Lumiracoxib^† Mavacoxib^‡ Parecoxib Robenacoxib^‡ Rofecoxib^† Valdecoxib^†
other	Aminopropionitrile Benzydamine Chondroitin sulfate Diacerein Fluproquazone Glucosamine Glycosaminoglycan Hyperforin Nabumetone Nimesulide Oxaceprol Proquazone Superoxide dismutase / orgotein Tenidap
NSAID combinations	Ibuprofen/famotidine Ibuprofen/hydrocodone Ibuprofen/oxycodone Ibuprofen/paracetamol Meloxicam/bupivacaine Naproxen/diphenhydramine Naproxen/esomeprazole
Key: underline indicates initially developed first-in-class compound of specific group; ^#WHO-Essential Medicines; ^†withdrawn drugs; ^‡veterinary use.
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