Antidopaminergic anti-emetics (ADAs) prevent and treat nausea and vomiting arising from migraine, chemotherapy, radiotherapy and postoperatively but may also increase the risk of ischaemic stroke, say French researchers.

Previous studies have linked antidopaminergic anti-psychotics with an increased ischaemic stroke risk, which seems to be particularly marked in older people, those with dementia and soon after starting treatment.

The risk of ischaemic stroke is, for example, 12 times higher during the first month of antipsychotic use but then reaches that of non-users after three months.

The study included 2,612 patients, with a mean age of 71.9 years, who were admitted to hospital following their first ischaemic stroke. People receiving ADAs were over three times more likely to experience an ischaemic stroke than matched controls.

The risk was almost five times higher in those patients who took ADAs during the seven days before the stroke.

ADAs block D2 dopamine receptors in the chemoreceptor trigger zone and GI tract. Metoclopramide (OR 3.53 for ischaemic stroke) and metopimazine (OR 3.62) cross the blood brain barrier, unlike domperidone (OR 2.51), which may contribute to the higher risk of ischaemic stroke with these ADAs.

Further studies need to confirm the association and determine if the link varies across the subtypes of ischaemic stroke. (BMJ 2022; 376:e066192)