Nicergoline for Neuromuscular Oropharyngeal Dysphagia: A Double-Blind, Placebo-Controlled Randomized Trial.

Abstract

Neuromuscular oropharyngeal dysphagia impairs the coordinated neurologic and muscular mechanisms of deglutition, predisposing patients to aspiration pneumonia, malnutrition, and diminished quality of life. Substance P participates in the swallow reflex; nicergoline, an ergot derivative, increases substance P concentrations, yet its therapeutic effect on dysphagia remains uncertain. We conducted a double-blind, randomized, placebo-controlled trial to determine whether nicergoline improves swallow function, quantified by the visual analog scale and flexible endoscopic evaluation of swallowing. Forty-four patients with neuromuscular oropharyngeal dysphagia were randomized to receive nicergoline 30 mg daily (n = 21) or matched placebo (n = 23) for 4 weeks. Baseline and week-4 visual analog scale scores, flexible endoscopic evaluation of swallowing scores, and penetration-aspiration scale ratings were compared within and between groups. Thirty-eight participants completed the study (nicergoline n = 19; placebo n = 19). Changes in visual analog scale and flexible endoscopic evaluation scores did not differ significantly between groups. However, nicergoline produced a statistically significant reduction in penetration-aspiration scale score, indicating enhanced airway protection during swallowing. These data suggest that nicergoline augments swallow safety in neuromuscular oropharyngeal dysphagia and may offer a therapeutic option for its management.