Drug Insight: from disturbed motility to disordered movement—a review of the clinical benefits and medicolegal risks of metoclopramide

Abstract

Metoclopramide, the only drug approved by the FDA for treatment of diabetic gastroparesis, but used off-label for a variety of other gastrointestinal indications, has many potentially troublesome adverse neurologic effects, particularly movement disorders. In this article, we comprehensively review the indications and side effects of metoclopramide, and describe some common pitfalls and strategies to minimize the medicolegal risks to the prescribing physician. Metoclopramide accounts for nearly a third of all drug-induced movement disorders, a common reason for a malpractice suit. The entire spectrum of drug-induced movement disorders, ranging from subtle to life-threatening, can ensue from its use; akathisia and dystonia are generally seen early in the course of metoclopramide-induced movement disorders, whereas tardive dyskinesia and parkinsonism seem to be more prevalent in chronic users. Female sex, age and diabetes are the major risk factors for metoclopramide-induced movement disorders. It is therefore incumbent on gastroenterologists and other prescribing physicians to become familiar with the adverse neurologic effects associated with the use of metoclopramide, and to take appropriate preventive and defensive measures.

Identification of Novel Metoclopramide Metabolites in Humans: In Vitro and In Vivo Studies

“…MCP is associated with neurologic side effects because of its action on central dopaminergic receptors. These neurologic effects consist of a broad spectrum of syndromes known as drug-induced movement disorders (DIMDs) (Pasricha et al, 2006). DIMDs can be acute or chronic and vary in their severity.…”

“…It is associated with central nervous system side effects. Clinically, the neurologic effects of MCP result in a broad spectrum of drug-induced movement disorders (Pasricha et al, 2006). These can range from acute dystonic reactions and parkinsonism to chronic tardive dyskinesia.…”

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

“…TD not only occurs in the psychiatrically ill, but also in nonpsychiatric patients exposed to antipsychotics or other dopamine receptor blocking agents such as metoclopramide. As a result, it has been the subject of intense medico-legal scrutiny [5]. While there have been numerous attempts to review varied agents in the treatment of TD [1,6], until very recently there were no evidencebased guidelines for physicians confronted with this disorder.…”

Doktor Gozlerimi Kontrol Edemiyorum!

“…Metoklopramidin dopamin reseptör antagonizmasına bağlı ortaya çıkan ekstrapiramidal semptomlar en önemli yan etkileridir. [2] Bu nedenle tedavi dozlarında dahi yan etkiler ortaya çıkabilir. Akut distonik reaksiyonlar, metoklopramid tedavisinin sıklıkla 1-3. günlerinde, özellikle çocuklarda ve genç erişkinlerde görülen bir yan etkidir ve yüz, boyun ve sırt kasların-da kontraksiyonlar, opistotonus, tortikolis, okulogirik kriz ve trismus ile kendini gösterebilir.…”