What are your views on Metoclopramide versus maropitant?

RE: What are your views on Metoclopramide versus maropitant?

Lindsey Edwards — Sun, 04 Jun 2023 22:06:20 GMT

I will use single inj of maropitant but very slow to repeat without rads if vomiting recurs unless I have alternative diagnosis (eg controlling vomiting from confirmed nonsurgical cause). Breakthrough vomiting makes me very suspicious of potential FB or extraluminal obstruction

RE: What are your views on Metoclopramide versus maropitant?

Julie Innes — Thu, 01 Jun 2023 10:51:43 GMT

I'm also old, and also believe you don't use metoclop if there is any possibility of a FB, whereas maropitant you can use with caution, as not prokinetic.

RE: What are your views on Metoclopramide versus maropitant?

janine redman — Tue, 30 May 2023 20:49:59 GMT

I tend to use maropitant as an anti emetic and reserve metoclopramide for its pro kinetic properties. So I would have hoped to rule out foreign bodies before using metoclopramide.

RE: What are your views on Metoclopramide versus maropitant?

Silvia Maldonado — Tue, 30 May 2023 11:04:56 GMT

I'm with Clive. Some cases of obstructive FB responding to maropitant, quite a few aggressive pancreatitis not responding to maropitant.

In general, I agree. No response to maropitant in a possible FB case lean the balance toward ex-lap. However, we still need to see the whole pic. If the dog is passing diarrhoea, for instance, an obstruction is less likely (maybe partial? will it pass?). If s/he stops vomiting after being given maropitant, you may still have a FB.

We need Idexx to make a snap FB test for us ;)

RE: Metoclopramide versus maropitant

bevs2251 — Tue, 30 May 2023 07:00:19 GMT

Had one just last week. One vet gave Maropitant, second vet gave metoclopramide (had been vomiting on and off for a few days - 12 year old GreyHound). Came back in a few hours later screaming in pain - obstructive pattern on radiograph. Emergency ex-lap. Acute intussusception with a corresponding intramural/extramural mass at this site. Resection and anastomosis performed. Mass turned out to be an osteosarcoma !! Vet that operated knew of this complication with Metoclopramide and intussusceptions but had never experienced one before in over 40 years practice.

RE: Metoclopramide versus maropitant

Clive Ansell — Mon, 29 May 2023 16:11:47 GMT

[quote userid="4747" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30671/metoclopramide-versus-maropitant/241647#241647"]Yes I also think that obstructed dogs vomit despite maropitant.[/quote]

Not always.

We had a case over the last bank holiday weekend; presented on the thursday morning vomiting with no other signs. Responded initially to Maropitant, but began vomiting again Friday evening and was seen OOH, and given more Maropitant. Same thing happened twice more over the bank holiday weekend. So in total 4 Maropitant injections and no vomiting at all while the drug was on board for >24 hours each time. We saw the dog again on the Tuesday after the long weekend, very ill, obstructed and then perforated bowel, half a tennis ball. Surgery was unsuccesful, wound breakdown, septic peritonitis. and was PTS.

Had a case about a year ago, where a beagle recovering from raw diet induced Campylobacter was receiving daily Maropitant. Then decided to eat some rat poison, but Apomorphine was ineffective whilst Maropitant was on board, even at the maximum data sheet dose. Dog did a similar thing about a week later with Chocolate. On both occasions owners declined anaesthesia for gastric lavage. Survived.

It seems Maropitant is a very powerful, very effective, anti-emetic. To be used with caution.

RE: Metoclopramide versus maropitant

Charlotte Marshall — Mon, 29 May 2023 15:56:05 GMT

Yes I also think that obstructed dogs vomit despite maropitant.

RE: Metoclopramide versus maropitant

Clive Ansell — Mon, 29 May 2023 10:46:00 GMT

[quote userid="4747" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30671/metoclopramide-versus-maropitant"]I was taught to never give metoclopramide if there was any chance that there might be an obstruction.[/quote]

That is my understanding too.

From the Vomend (metoclopramide) data sheet

"Do not use in cases of gastrointestinal perforation or obstruction."

Clinical particulars - Vomend® 5 mg/ml Solution for Injection for Dogs and Cats (noahcompendium.co.uk)

RE: Metoclopramide versus maropitant

Yantha Smyth — Mon, 29 May 2023 08:21:41 GMT

I too am old! Ha ha. My understanding has always been the metoclopramide is contraindicated if obstruction not ruled out due to its pro kinetic activity. Whereas maropitant acts differently so would not bear the same risk if obstructive disease is present. I think the theoretical risk of using maropitant in an obstructed animal is that it is very effective, so could delay diagnosis? My anecdotal experience though is that obstructed dogs vomit through maropitant, and doing so helps support the suspicion of obstruction!

RE: Metoclopramide versus maropitant

Michael Woodhouse — Sun, 28 May 2023 23:31:55 GMT

I'm old, so my view mirror's yours. The only other (non scientific) thing I have to add was the old view - if it vomits through metoclopramide then it's surgical. Maropitant more powerful and will stop them being sick. I remember in the distant past 2 dogs PTS on the table with linear FB given metoclopramide, clearly a much more powerful prokinetic.