Efficacy and Safety of Pharmacologic Therapies for Nausea and Emesis in the Emergency Department: A Systematic Review and Bayesian Network Meta-analysis.
deSouza IS, et al. Ann Emerg Med. 2025 Dec;86(6):646-658. doi: 10.1016/j.annemergmed.2025.06.009.
Methodology: 3/5
Usefulness: 1/5
Question and methods: The authors utilized a network meta-analysis to identify the most effective and safest anti-emetic for use in the emergency department in adult patients over the age of 18.
Findings: The network meta-analysis demonstrated that 4 drugs are better than placebo in need for a rescue drug. The network meta-analysis demonstrated with moderate certainty that 2 agents are associated with increased likelihood of adverse reactions.
The main agents identified in papers in their systematic review:
- Tropisetron
- Prochlorperazine
- Metoclopramide
- Droperidol
- Ondansetron
- Promethazine
Limitations: The assumption of transitivity was questioned by the authors given evidence of clinical heterogeneity. Additionally, current outcomes do not demonstrate effectiveness, and a network meta-analysis was unable to be completed for change in nausea.
Interpretation: There is not enough evidence to change current first line options in patients presenting with nausea/emesis to the emergency department.
