High exposure compared with standard exposure to metoclopramide associated with a higher risk of parkinsonism: a nationwide population‐based cohort study

Tsai, Shin Chia; Sheu, Sheh Yi; Chien, Li‐Nien; Lee, Hsin Chien; Yuan, Eunice J.; Yuan, Rey Yue

doi:10.1111/bcp.13630

Cited by 9 publications

(7 citation statements)

References 47 publications

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Section: Resultsmentioning

confidence: 99%

“…Given its non-narcotic and antiemetic properties, metoclopramide should be considered a primary agent in treating acute migraines in the emergency room; however, its undesirable effects (e.g., acute dystonia, parkinsonism) require caution and being knowledgeable about the patient's previous experiences with other antidopaminergics. [111][112][113] Intravenous ketorolac is recommended as first-line symptomatic therapy in CM patients with moderate to severe attacks without severe vomiting or nausea. We recommend doses of 30-60 mg (strong recommendation, moderate quality of evidence, 1B).…”

Section: Most Effective Treatments (Traditional and New) In CM For Acute Headaches Associated With Nausea Vomiting And Disabilitymentioning

confidence: 99%

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Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Vélez-Jiménez

Chiquete-Anaya

Orta

et al. 2021

Cephalalgia Reports

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Introduction: Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods: Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results: We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions: We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.

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Section: Resultsmentioning

confidence: 99%

Section: Most Effective Treatments (Traditional and New) In CM For Acute Headaches Associated With Nausea Vomiting And Disabilitymentioning

confidence: 99%

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Vélez-Jiménez

Chiquete-Anaya

Orta

et al. 2021

Cephalalgia Reports

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“…Another study from Taiwan which included 218,931 metoclopramide users (57.9% female, median age of 41 years and 83.39% were < 60 years of age) reported a similar low prevalence of drug-induced parkinsonism associated with metoclopramide (0.06%) over a one-year period. 11 However it also reported that risk was twofold higher compared to non-users (aHR = 2.16; 95% CI = 1.54-3.02). Those in the high exposure group (>30 mg/day and/or duration >5 days) had a 1.83 fold higher risk than standard users (≤30 mg/day and/or duration ≤5 days).…”

Section: Discussionmentioning

confidence: 96%

Antidopaminergic‐Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease

Singh

Cocoros

Haynes

et al. 2021

J American Geriatrics Society

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OBJECTIVES: Persons living with Alzheimer's disease (AD) may be at increased risk for prescribing cascades due to greater multimorbidity, polypharmacy, and the need for more complex care. Our objective was to assess the proportion of the antidopaminergic-antiparkinsonian medication prescribing cascades among persons living with Alzheimer's disease. SETTING: Two large administrative claims databases in the United States. PARTICIPANTS: We identified patients aged ≥50 on January 1, 2017, who were dispensed a drug used to treat Alzheimer's disease for at least 1 day in the 365 days prior to or on cohort entry date and who had medical and pharmacy coverage in the 365 days prior to the cohort entry date. We excluded individuals with a recent institutional stay. We identified incident antidopaminergic (antipsychotic/metoclopramide) use in the 183 days following cohort entry and identified subsequent incident antiparkinsonian drug use within 8 to 365 days. RESULTS: There were 121,538 patients with Alzheimer's disease eligible for inclusion. Approximately 62% were women with a mean age of 79.5 (SD AE 8.6). The mean number of drugs dispensed was 9.2 (SD AE 4.9). There were 36 incident antiparkinsonian users among 4,534 incident antipsychotic/metoclopramide users (0.8%). CONCLUSION: We determined that the proportion of antidopaminergic-antiparkinsonian medication prescribing cascades, widely considered as high-priority, was low. Our approach can be used to assess the proportion of prescribing cascades in populations considered to be at high risk and to prioritize system-level interventional efforts to improve medication safety in these patients.

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“…Patients received metoclopramide more than 30 mg per day or a prescription of duration more than 5 days were defined as high-exposure users. 23 Our study additionally assembled the cumulative dose and duration in the study period to assess the dose–response and duration–response effect in the metoclopramide use and the risk of Parkinsonism. Furthermore, we estimated the risk for the continuous period of metoclopramide use.…”

Section: Discussionmentioning

confidence: 99%

Metoclopramide as a prokinetic agent for diabetic gastroparesis: revisiting the risk of Parkinsonism

Lai

Yeh

Chen

2019

Therapeutic Advances in Drug Safety

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Background: Metoclopramide is used to relieve gastrointestinal symptoms, however, it could cause adverse reactions of motor disorders. The aim of this study was to investigate whether metoclopramide treatment has a duration–response or dose–response effect and to estimate the risk of developing Parkinsonism following different and specific durations of treatment. Methods: A cohort study of newly diagnosed type 2 diabetes mellitus in 45- to 79-year-old patients, between 1999 and 2008, was selected using the Longitudinal Health Insurance Database 2005. A nested case–control study was conducted in the diabetes cohort in which all incident cases of Parkinsonism were identified. We randomly matched each case with up to 10 controls from the risk set. Conditional logistic regression was utilized to estimate odds ratio of Parkinsonism associated with metoclopramide use. Results: A total of 34,685 patients with diabetes were assembled as the cohort, and 541 incident Parkinsonism cases were identified. There were duration–response and dose–response effects on the risk of developing Parkinsonism. Compared with never-use patients, the adjusted odds ratios (ORs) of continuing therapy for 0–1 month, 1–2 months, 2–3 months, 3–5 months, and more than 5 months were 1.17 [95% confidence interval (CI) 0.93–1.45], 1.44 (95% CI 1.04–2.00), 1.74 (95% CI 1.14–2.65), 1.90 (95% CI 1.23–2.93), and 2.17 (95% CI 1.50–3.12), respectively. Conclusions: With metoclopramide treatment, regardless of less or more than 3 months of use, the risk of developing Parkinsonism in patients with newly diagnosed diabetes escalated with the duration of therapy. Therefore, we recommend close monitoring for the development of Parkinsonism in patients treated with metoclopramide, particularly (but not limited to) those with prolonged exposure.

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High exposure compared with standard exposure to metoclopramide associated with a higher risk of parkinsonism: a nationwide population‐based cohort study

Cited by 9 publications

References 47 publications

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Antidopaminergic‐Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease

Metoclopramide as a prokinetic agent for diabetic gastroparesis: revisiting the risk of Parkinsonism

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