HWN Suggests

GI Cocktails: What Should You Know?

Although GI cocktails were once widely used to treat indigestion, their use isn’t recommended as often these days. “Studies don’t really recommend using GI cocktails anymore,” says Onyilofor. “Now we see our providers order more specific medications, depending on what the patient’s symptoms are.” There was never any clear, up-to-date evidence suggesting they are particularly effective.‌ Some studies found that GI cocktails were only as effective as plain antacids.‌ In the past, GI cocktails may have contained a medication called Donnatal, which contains belladonna and phenobarbital, says Chisom Onyilofor, PharmD, clinical pharmacy manager at MedStar Health in Maryland. There were many concerns…

read full article

Featured

 Don’t use lidocaine for epigastric pain

Medical practice can be very hard to change. I have previously covered a paper from 2003 that showed that the “pink lady” or “GI cocktail” provides no benefit to patients, but lidocaine is still widely used for epigastric pain in emergency medicine. Of course, that prior paper was somewhat messy, as it included an anticholinergic in the GI cocktail, so maybe people were just waiting for a cleaner RCT to change their practice. If that was the case, here is the trial you have been waiting for.

 The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial

In conclusion, the addition of Donnatal or Donnatal + lidocaine to an antacid did not relieve dyspepsia better than plain antacid. The "GI Cocktail" concoction may not be necessary.

Articles of Interest

And Thus Ends the GI Cocktail

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.

Do Antacid Monotherapy or GI Cocktails Work Better for Epigastric Pain?

Participants found antacid monotherapy to be the most palatable solution. The most frequent adverse effect was oral numbness. It was only reported in the lidocaine solution (26 percent) and viscous group (20 percent), not in the antacid monotherapy group.

GI Cocktail Wasn’t the Cocktail Alcoholic Patient Had in Mind

Proud alcoholic Steven D’Amato presented to the Emergency Department (ED) of Louisville Medical Center (LMC) with minor withdrawal symptoms and mild stomach upset, looking for something to help settle his nerves. D’Amato was highly disappointed because the GI cocktail he was given just wasn’t the kind of cocktail he had in mind.

GI Cocktail: How It Works and When You Should Consider It

A GI cocktail should never be used to differentiate between cardiac and gastrointestinal chest pain. Response to treatment does not rule out cardiac causes, and proper cardiac evaluation remains essential for chest pain presentations.

Have You Ever Tried Viscous Lidocaine?

The literature, albeit modest evidence from small studies, demonstrates that lidocaine does not reduce patients' symptoms. And most patients (and staff) believe it tastes awful. The next time you consider giving it, try it yourself first.

Stop Giving Lidocaine in “GI Cocktails”

“GI cocktails” are commonly used in the Emergency Department for epigastric discomfort, but the evidence behind “cocktail” components is lacking and while lidocaine is commonly used, a trial by Berman et al found no benefit (versus a prior RCT in 1990 with high risk of bias).

The Death of the “GI Cocktail”

This small randomized, controlled trial found no benefit to adding lidocaine to antacids in emergency department patients with epigastric pain or dyspepsia.

Using the "GI cocktail": a descriptive study

Although symptomatic relief after administration of a GI cocktail is often noted, it is difficult to differentiate the effects of the cocktail from those of other coadministered medications such as morphine or nitroglycerin. We urge ED physicians to use the GI cocktail in a rational manner.