Abstract
Objectives
To evaluate efficacy and satisfaction of dextromethorphan as a non-narcotic adjuvant
to current analgesic regimens for medication abortion.
Study Design
We conducted a randomized, double-blinded, placebo-controlled trial. We randomized
eligible participants (N = 156) 1:1 to adjunctively take dextromethorphan (loading dose 60 mg and two subsequent
30 mg doses at 2 and 5 hours after misoprostol administration) or placebo combined
with usual-care nonsteroidal anti-inflammatory medications ± opioids for pain. Participants
reported pain scores and satisfaction using a secure texting application at 2, 5,
8, and 24 hours after misoprostol administration. Our primary outcome was worst pain
score and total analgesic use.
Results
Baseline demographics of enrolled participants were similar between randomization
arms. Worst pain scores for participants receiving dextromethorphan versus placebo
(8.0 vs 7.0, p = 0.06) did not differ. Total milligram usage of ibuprofen (800 mg vs 610 mg, p =.62), acetaminophen (1000 mg vs 1300 mg, p = 0.62), and opioids (10 mg vs 15 mg, p = 0.51) did not differ between the randomization groups. Participants randomized
to placebo were significantly more likely to be satisfied with their pain control
(91% vs 75%, p = 0.02).
Conclusion
Dextromethorphan used adjunctively with standard analgesics did not reduce pain associated
with medication abortion. Participants who received dextromethorphan reported decreased
satisfaction with their pain control.
Implications
Dextromethorphan used adjunctively with commonly used analgesic regimens did not reduce
medication abortion associated pain. Many participants did not use analgesics as counseled,
and nearly 25% used no analgesia during medication abortion.
Keywords
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Article Info
Publication History
Published online: November 01, 2022
Accepted:
October 21,
2022
Received in revised form:
October 18,
2022
Received:
September 13,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
