Discussion Antiemetic regimens: ahead vs. stat

[Superfluous]

I'm curious as to why most people prefer ahead regimens over stat when it comes to taking antiemetics. I've composed the following table showing concentrations of meto in the body when using the 48 hour ahead regimen with 20mg doses every 8 hours. The half life of meto is 6 hours. It's not perfect as I haven't incorporated uptake times (as I don't know them), but if I did so, the concentration values would be slightly lower than detailed here.

This has taken a few hours to compose as I'm stuck with an old tablet and touchscreen controls. I had to use bbcode to make the table...

I used the following resource to provide the hourly figures as I couldn't work out how to do the formula myself:

Half Life Calculator

This half life calculator calculates the remaining amount of a substance after a certain period of time has transpired.

www.learningaboutelectronics.com

Time (hours)	Ingested (mg)	Remaining (mg)
0	20	20
1		17.81797436
2		15.87401052
3		14.14213562
4		12.5992105
5		11.22462048
6		10
7		8.908987181
8	20	27.93700526
9		24.88904217
10		22.17361577
11		19.75444587
12		17.5992105
13		15.67911407
14		13.96850263
15		12.44452109
16	20	31.08680788
17		27.6951973
18		24.67361577
19		21.98169266
20		19.58346181
21		17.44688103
22		15.54340394
23		13.84759865
24	20	32.33680788
25		28.80882069
26		25.66574142
27		22.86557613
28		20.37091247
29		18.1484198
30		16.16840394
31		14.40441034
32	20	32.83287071
33		29.25076243
34		26.05946675
35		23.21634552
36		20.68341247
37		18.42682565
38		16.41643536
39		14.62538121
40	20	33.02973338
41		29.42614713
42		26.21571676
43		23.35554845
44		20.80742818
45		18.53731109
46		16.51486669
47		14.71307356
48	20	33.10785838
49		29.49574859

So as you can see, based on this specific regimen, at the time you take your substance of choice your system will only contain around 30mg of meto (I added the extra row to incorporate the wait time after the final dose).

Is there some other benefit to using the ahead regimen other than avoiding any potential side effects from taking a 40mg stat dose?

 

[Rez_MbChB]

If no one else does will answer either tonight when I'm out of theatre or tomorrow :)

 

[bilamajina]

Well I'm waiting with bated breath @Rez_MbChB, as I'm interested I your reply.

 

[LaBrava]

Isn't 10mg the suggested dose?

 

[Letmego. Please]

My take from that table you brilliantly compiled is that doing the 48hr route leaves you with excess Meto in your system prior to you taking the next dose, which to me seems to increase the chances of unwanted EP effects.

But i may be wrong, still need more caffeine as ever.

 

[Superfluous]

Well I'm waiting with bated breath @Rez_MbChB, as I'm interested I your reply.

@Rez_MbChB is very busy with work at the moment. We've had a chat today and, whilst it's not exactly their field of expertise, I do have some information that I'll post in a simplified form in a mo

Isn't 10mg the suggested dose?

Please don't ask me to do the same for a 10mg dose . I think you may be able to simply divide all the quantities by a factor of 2.

I'm working from this Wikibooks source, and there are several recommendations suggested:

Suicide - Wikibooks, open books for an open world

en.m.wikibooks.org

I chose to model Dr. Nitschke's advice (PPeH guy).

My take from that table you brilliantly compiled is that doing the 48hr route leaves you with excess Meto in your system prior to you taking the next dose, which to me seems to increase the chances of unwanted EP effects.

That was pretty much my thoughts also. I was just curious as to whether there was more to it.

Now, I should first state that this table only relates to Metoclopramide, and I stated that the half life is 6 hours. I know I read that somewhere, but I can't for the life of me remember where.

I found this excellent resource on the pharmacodynamic properties of Domperidone:

Domperidone 10mg Tablets - Summary of Product Characteristics (SmPC) - (emc)

Domperidone 10mg Tablets - Summary of Product Characteristics (SmPC) by Aurobindo Pharma - Milpharm Ltd.

www.medicines.org.uk

Unfortunately, whilst there is also an equivalent page on the same site for Metoclopramide, it doesn't provide anywhere near the same level of detail:

Metoclopramide 10mg Tablets - Summary of Product Characteristics (SmPC) - (emc)

Metoclopramide 10mg Tablets - Summary of Product Characteristics (SmPC) by Accord-UK Ltd

www.medicines.org.uk

So, to briefly summarise my conversation with Rez_MbChB, it may simply be to help reduce the risk of side effects and to ensure you have the required level in your system at the time of drug ingestion (note that the stat dose recommended by Dr. Nitschke on the same resource is 60mg Metoclopramide), but it may be possible that, as happens with some drugs, the half life could increase over time. I can't go into detail as to why this would be as I'm a bit out of my depth, and we can't be sure if this is the case with either Metoclopramide or Domperidone.

Also bear in mind that this resource page relates to generic antiemetic regimens and not to any specific drug method. Specific drug methods may require different regimens.

 

[bilamajina]

@Superfluous, with regards to Dr. Nitschke's Metoclopramide model, the wiki is out of date. In the March 2019 PPH he recommends the following for stat:
30mg 30 minutes in advance (page 153)
20-30mg 1 hour in advance (page 181)
30mg about 1 hour in advance (page 182)

In the April 2019 livestream he recommends 40 minutes in advance (no dose stated).

NB: The time inconsistencies.

For non-stat he recommends:
10mg every 8 hours for 48 hours (page 182)

He also says the following for non-stat:
"this regime removes the need to synchronise the taking of the lethal drug. It also serves to uncover any possible adverse effects of the drug" (page 182).

Plus:
"The suggested dose for Metoclopramide is independent of the type or quantity of the lethal drug to be used" (page 185).

The March PPH is posted here.

 

[Superfluous]

@Superfluous, with regards to Dr. Nitschke's Metoclopramide model, the wiki is out of date. In the March 2019 PPH he recommends the following for stat:
30mg 30 minutes in advance (page 153)
20-30mg 1 hour in advance (page 181)
30mg about 1 hour in advance (page 182)

In the April 2019 livestream he recommends 40 minutes in advance (no dose stated).

NB: The time inconsistencies.

For non-stat he recommends:
10mg every 8 hours for 48 hours (page 182)

He also says the following for non-stat:
"this regime removes the need to synchronise the taking of the lethal drug. It also serves to uncover any possible adverse effects of the drug" (page 182).

Plus:
"The suggested dose for Metoclopramide is independent of the type or quantity of the lethal drug to be used" (page 185).

The March PPH is posted here.

Thanks for the April livestream information, although it's a shame that he doesn't state a dose for the stat. Maybe we're meant to assume the dose is the same.

Please remember my model is just an example to illustrate the different levels of Metoclopramide in your system when comparing ahead to stat, and I'm just curious as to why that should be. Maybe it's related to the uptake, maybe there's another factor I'm missing. I'm pretty sure you can simply divide all the vales by 2 in the table for a 10mg ahead regimen, so we're comparing a value of just under 15mg for ahead to 30mg for stat.

I accept your argument that an ahead regimen would allow a larger window of opportunity so that's an excellent point, although I'm not sure by how much - I'm guessing no more than 30 minutes.

Also bear in mind everyone reacts differently to any drug.

As to why the dosages have changed in PPeH, I could argue that from a couple of angles.

If I were cynical, I could say that Dr. P needs to make regular changes in order to continue making money from his business. However, there is probably a more logical answer, and that's to do with risk management.

As we all know, there's a risk of EPS when using Metoclopramide. So, is it better to recommend a lower dosage of Metoclopramide and reduce the risk of EPS but increase the risk of failure due to vomiting? After all, EPS is a very nasty condition, and it's always possible to make another attempt at ending life.

 

[Ldog9]

@Superfluous, with regards to Dr. Nitschke's Metoclopramide model, the wiki is out of date. In the March 2019 PPH he recommends the following for stat:
30mg 30 minutes in advance (page 153)
20-30mg 1 hour in advance (page 181)
30mg about 1 hour in advance (page 182)

In the April 2019 livestream he recommends 40 minutes in advance (no dose stated).

So.. is 30, 40, or 1 hour in advance?

It seems like the stat dose ~1 hour prior seems to be the preferred method no? I dunno b/c it seems like a lot of ppl are doing the 2-3 day regime instead.

 

[Vegrau]

It will take 4 days for meto to disappear from our system. The reason we have regimen is because the effects stack and develop quicker the longer youre taking meto. Also they chose meto mainly for it's prokinetic ability.

 

[Superfluous]

So.. is 30, 40, or 1 hour in advance?

It seems like the stat dose ~1 hour prior seems to be the preferred method no? I dunno b/c it seems like a lot of ppl are doing the 2-3 day regime instead.

Exactly. And this is the reason for my post, because almost everyone goes for the ahead regimen, and I'd like to understand why. Dignitas do a stat dose, albeit in liquid form, 30mins prior (assuming the info on Wikibooks is still correct).

The reason we have regimen is because the effects stack and develop quicker the longer youre taking meto.

Can you provide a link to a reliable source for this, as this is exactly what I'm trying to ask.

Also they chose meto mainly for it's prokinetic ability.

Yes, as does domperidone.

Edit: meto is recommended primarily for it's dopamine blocking ability. It possesses some gastro-prokinetic properties which are useful.

 

[Roger]

What's prokinetic mean ?

 

[Superfluous]

Gastro-prokinetic means that it promotes emptying of the stomach contents into the intestinal tract which is where absorption occurs. It also helps that, if you vomit, there's nothing in the stomach to bring up.

 

[Camille Lejeune]

What's prokinetic mean ?

It increases gastrointestinal motility (meto works on your big intestine too!)

 

[Vegrau]

Yes, as does domperidone.

Nope. In my case dom is way way weaker, its borderlining non effective for the prokinetic effect. I tried both. Meto work perfectly. I would take meto if I can. But meto had such bad side effects I simply cannot continue using it.

Can you provide a link to a reliable source for this, as this is exactly what I'm trying to ask.

I used to post the links on the SN related threads. I just dont feel like looking for any right now. Maybe later when I am feel like it.

 

[Superfluous]

Nope. In my case dom is way way weaker, its borderlining non effective for the prokinetic effect. I tried both. Meto work perfectly. I would take meto if I can. But meto had such bad side effects I simply cannot continue using it.

I'm sorry that domperidone isn't effective for you. All drugs affect everyone differently.

I agree domperidone is weaker as is clearly documented.

I used to post the links on the SN related threads. I just dont feel like looking for any right now. Maybe later when I am feel like it.

I'm sorry you're not feeling well. I hope you feel better soon.

I'll do a search.

Thanks for your input.

 

[Vegrau]

I'm sorry that domperidone isn't effective for you. All drugs affect everyone differently. However, please don't discourage other users from perfectly valid and recommended alternatives. It's quoted in PPeH, Lost All Hope, Five Last Acts and Wikibooks.

Domperidone is weaker as is clearly documented, but using terms like "way way weaker" is not helpful unless you can provide valid quantitive data to back it up.


I'm sorry you're not feeling well. I hope you feel better soon.

I'll do a search.

Thanks for your input.

I am not discouraging anyone. No one is discouraging anyone here. I said it clearly. "IN MY CASE". What else must I say? If the drug doesnt work on me. I will say it doesnt work. Must I really lie? Also I am not feeling unwell. I am just lazy to search for it. Dont feel like searching for it. Since I already posted it somewhere.

I didnt managed to find the files regarding
the stacking effects of metoclopramide too back up my claim. So youre free to ignore it. Please ignore it because I have no prove. But I managed to find others. Also I am not doing this for you. So dont get ahead of yourself. I just thought other people need to see this. So dont thank me. I do this for myself and what I perceive as what I must do.

 

[Superfluous]

I am not discouraging anyone. No one is discouraging anyone here. I said it clearly. "IN MY CASE". What else must I say? If the drug doesnt work on me. I will say it doesnt work. Must I really lie? Also I am not feeling unwell. I am just lazy to search for it. Dont feel like searching for it. Since I already posted it somewhere.

I didnt managed to find the files regarding
the stacking effects of metoclopramide too back up my claim. So youre free to ignore it. Please ignore it because I have no prove. But I managed to find others. Also I am not doing this for you. So dont get ahead of yourself. I just thought other people need to see this. So dont thank me. I do this for myself and what I perceive as what I must do.

I apologise if I have upset you. I read your previous statement as 2 separate sentences. My mistake.

 

[Vegrau]

I apologise if I have upset you. I read your previous statement as 2 separate sentences. My mistake.

Dont worry about it. I am not upset. I am confrontational and stating the fact. This how I talk. Also I changed the earlier comment so people wont get the wrong ideas again. I thought putting in my case is enough to encapsulate my whole statement but apparently its not enough. What a good example of Qualia.

 

[Superfluous]

Dont worry about it. I am not upset. I am confrontational and stating the fact. This how I talk. Also I changed the earlier comment so people wont get the wrong ideas again. I thought putting in my case is enough to encapsulate my whole statement but apparently its not enough. What a good example of Qualia.

I've edited your quote in my post to reflect your changes and removed my negative comments.

Please accept my apologies once again.

 

[Vegrau]

I've edited your quote in my post to reflect your changes and removed my negative comments.

Please accept my apologies once again.

Its alright dont worry about it. Still thank you for doing it. I dont see it as negative. Just misunderstood.