Dystonic reactions and the pharmacokinetics of metoclopramide in children.

Bateman, D. N.; Craft, Alan; Nicholson, E.; Pearson, Andrew D.J.

doi:10.1111/j.1365-2125.1983.tb02090.x

Cited by 43 publications

(34 citation statements)

References 9 publications

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“…) Pharmacokinetic considerations may contribute to preo disposing factors in individuals susceptible to neurolepticinduced dystonia. Plasma drug levels do not differentiate between dystonic and non-dystonic patients (Garver et al 1976;Tune and Coyle 1981;Bateman et al 1983). However, measurement of membrane-bound neuroleptic drug concentration in red blood cells in one study of butaperazine revealed increased erythrocytic drug levels in dystonic patients as compared to those in neuroleptic-treated patients not developing dystonic reactions (Garver et al 1976).…”

Section: Incidencementioning

confidence: 99%

Acute dystonia induced by neuroleptic drugs

1986

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About 2.5% of patients treated with neuroleptic drugs develop acute dystonia within 48 h of commencing therapy. The symptoms remit on drug withdrawal or following anticholinergic therapy. Acute dystonia can also be reliably induced in many primate species by neuroleptic treatment with comparable time course, symptomatology and pharmacological characteristics to those observed in man. In general, New World monkeys appear more susceptible to acute dystonia than Old World primates. It is at present not clear whether all primates, including man, would exhibit dystonia if a sufficiently high dose of neuroleptic was administered. Alternatively, some unknown, possibly species-specific or even genetic, factors may determine an individual's susceptibility to develop dystonia. Use of a rodent model of dystonia might enable more detailed analysis of biochemical correlates of dystonic behaviour. Whilst rodents do not exhibit overt dystonic behaviour after neuroleptic treatment, they may develop oral dyskinesias which bear a close pharmacological similarity to dystonia in man and primates. However, it is not known whether chewing induced by neuroleptic drugs in rats resembles acute dystonia in primates or whether this is another movement disorder possibly unique to rodent species. The pathophysiology of acute dystonia remains unknown, but may involve striatal dopaminergic and cholinergic function. In view of the close similarity between dystonia in man and other primates, studies on the mechanisms whereby neuroleptic drugs cause acute dystonic reactions in monkeys may give some clues to the pathogenesis of spontaneous dystonia in man.

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Section: Incidencementioning

confidence: 99%

Acute dystonia induced by neuroleptic drugs

1986

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“…Acute dystonia usually occurs three to five days after antipsychotic therapy begins or the dosage is increased [10]. Although there was a history of metoclopramide overdose in our patient, it is reported that there was no difference in plasma concentration of metoclopramide of children with dystonia when compared to those without this side effects [7]. Our patient did not receive any other drug other than metoclopramide.…”

Section: Discussionmentioning

confidence: 70%

“…Cezard et al reported that there is no dose-effect correlation and sex has no influence on the occurrence of neurological symptoms [6]. Bateman et al reported that there was no difference in plasma concentration of metoclopramide of children with dystonia when compared to those without these side effects [7]. Hyser et al reported that metoclopramide clearance is reduced in renal failure, and myoclonus or other neurologic complications may be precipitated in such patients by usual doses of this drug [3].…”

Section: Discussionmentioning

confidence: 99%

Metoclopramide induced intermittent opisthotonos in infant

et al. 2010

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AbstractMetoclopramide is widely used as an antiemetic and a prokinetic agent. Both the antiemetic properties and side effects of the drug are the result of dopamine receptor antagonism within the central nervous system. Therapeutic doses of metoclopramide can produce adverse effects. A 5-month-old girl was referred to our emergency department with the pre-diagnosis of afebrile convulsion. In her medical history, she was mistakenly given 2 mg/kg metoclopramide within a 24 h period, after which she became hypertonic and exhibited intermittent opisthotonos. Complete blood count, electrolytes, liver and renal function tests, blood gas analysis, and urinalysis were all within normal limits. Electroencephalogram, brain CT and cerebrospinal fluid examination were normal. Metoclopramide treatment was discontinued and she was treated with biperiden, which led to an improvement in symptoms after 15 minutes and complete remission in 60 minutes. Intermittent opisthotonos may be confused with convulsion in infant and thus lead to an unnecessary hospital admission. Physicians should be aware that metoclopramide is widely used in the pediatric population and children are susceptible to the side effects of metoclopramide and the side effects may present as “intermittent opisthotonos” as observed in our patient.

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“…Moreover, it should be noted that the removal of cisapride from the therapeutic choices would leave metoclopramide, erythromycin, and domperidone as primary treatment options. These alternate drugs are also not without potentially severe side effects, also including prolongation of the QT interval [26,27,28,29]. Recently, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition reconfirmed that "cisapride has a place in pediatric therapeutics when used in conditions in which a prokinetic drug is indicated" [30].…”

Section: Discussionmentioning

confidence: 98%

Effect of cisapride on rate-corrected QT intervals in children on peritoneal dialysis

et al. 2002

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The aim of this study was to investigate whether cisapride significantly increases corrected QT (QTc) intervals on resting 12-lead electrocardiograms (ECGs) in children on peritoneal dialysis. Medical records of children who were treated with chronic peritoneal dialysis and who had ECGs while off and on cisapride were obtained and reviewed. QTc on all 12-lead ECGs and past medical history were analyzed by two blinded pediatric cardiologists. A total of 79 ECGs (68 off/11 on cisapride) for 11 children on peritoneal dialysis were included. Of 11 children, 5 developed a prolongation of QTc, 2 of them beyond the normal range (453 and 478 ms). Mean data of QTc off versus on cisapride were 394+/-24 ms and 414+/-36 ms, respectively ( P=0.041). In 4 of the 5 children concomitant medications could be identified as factors to explain prolongation of the QT interval. No child had evidence of any arrhythmia or conduction defect on ECG. This retrospective study found mild but significant increases in QTc intervals with cisapride in children on chronic peritoneal dialysis, mostly due to concomitant medications.

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Dystonic reactions and the pharmacokinetics of metoclopramide in children.

Cited by 43 publications

References 9 publications

Acute dystonia induced by neuroleptic drugs

Acute dystonia induced by neuroleptic drugs

Metoclopramide induced intermittent opisthotonos in infant

Effect of cisapride on rate-corrected QT intervals in children on peritoneal dialysis

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