Aspirin with Metoclopramide

How it works

Aspirin relieves migraine pain by inhibiting cyclo-oxygenase and prostaglandin synthesis, while metoclopramide controls nausea and, by promoting gastric emptying, enhances aspirin absorption during an attack.

Prescribing in practice

• Metoclopramide can cause acute dystonic and other extrapyramidal reactions, particularly in younger patients, so use is restricted to short-term acute treatment; aspirin adds the usual gastrointestinal bleeding and Reye's-syndrome cautions.
• Avoid the aspirin component in active peptic ulcer disease, bleeding disorders and aspirin hypersensitivity, and the combination in children and young people.
• It should be used only for acute attacks, not for frequent or prophylactic use, to avoid medication-overuse headache and cumulative metoclopramide exposure.

Monitoring

No routine monitoring is needed for occasional use; watch for extrapyramidal reactions and gastrointestinal bleeding.

Counselling the patient

• Use only for acute migraine attacks and avoid frequent use to prevent rebound headache.
• Seek urgent help if you develop abnormal muscle spasms, especially of the face, neck or eyes.
• Take with food and report any black stools or stomach pain.

Evidence & guidelines

Aspirin combined with an antiemetic is recommended by NICE as an option for the acute treatment of migraine.