And Thus Ends the GI Cocktail

Written by Clay Smith

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Antacid monotherapy is as effective, if not more effective, than GI cocktails with lidocaine, is more palatable, and has fewer side effects.

Why does this matter?
In prior studies, it is questionable whether additives like lidocaine or donnatal are…well additive to effectiveness beyond a simple antacid.

Feel the burn…or not
This was a single-blinded RCT with 89 patients with reflux-type pain who were randomized to antacid monotherapy (aluminum hydroxide/magnesium trisilicate/magnesium hydroxide), antacid/lidocaine 2% solution, or antacid/lidocaine 2% viscous gel. For the primary outcome of pain reduction on visual analog scale (VAS) at 30 minutes, both antacid and antacid+solution gave clinically significant pain reduction. VAS reduction in pain was 20 (antacid), 17 (antacid+solution), and 9 (antacid+viscous). The viscous group did not meet >13mm VAS decrease considered clinically important. There was no statistical difference between the three groups. Antacid alone was (non-significantly) more effective than all the others. It was also the most palatable. Both lidocaine preparations caused oral numbness. All three provided pain relief >13mm at 60 minutes. The take-home point is that a plain antacid is as effective, if not more effective, that GI cocktails with lidocaine, is more palatable, and has fewer side effects.

Antacid monotherapy is more effective in relieving epigastric pain than in combination with lidocaine. A randomized double-blind clinical trial. Acad Emerg Med. 2020 Jun 29. doi: 10.1111/acem.14069. Online ahead of print.

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2 thoughts on “And Thus Ends the GI Cocktail”


    It would have been helpful if the study considered the use of a GI cocktail for use of controlling nausea, especially for patients that can’t take other antiemetic medications due to QT prolongation.

What are your thoughts?

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