Metoclopramide: A Safe Alternative to Domperidone? A Case Report on Severe Cardiac Adverse Effects in an Older Patient

Abstract

Peripheral antidopaminergic medication is frequently prescribed to treat nausea. However, domperidone is ill-famed for its severe cardiac adverse effects. Metoclopramide has been suggested as a relatively safe alternative because it has long been considered to have less significant cardiovascular adverse effects. We present an older patient who developed severe bradycardia and hypotension shortly after receiving intravenous metoclopramide. Cardiac adverse effects of metoclopramide in elderly are not frequently described in the literature, especially not in patients without a major history of cardiac disease. We recommend caution with intravenous administered metoclopramide in older patients.

Association between Domperidone Administered via Feeding Tube and Feeding Success in Critically Ill Patients with Enteral Feeding Intolerance

“…It remains unclear whether domperidone exposure definitely increases the risk of sudden cardiac death and death associated with ventricular arrhythmia [ 22 ]. Some studies have indicated a risk for severe cardiac adverse effects after exposure to both metoclopramide and domperidone [ 22 , 23 ]. It has been suggested that domperidone may not be associated with an increased risk of cardiovascular events at doses below 30 mg/day and does not result in QT prolongation [ 24 ].…”

Evaluation of gastric emptying by ultrasonography after recommended fasting period and administration of prokinetic in end-stage renal disease patients

“…[ 15 ] There are many drugs such as domperidone, cisapride, and erythromycin, which increases gastric motility. [ 16 17 18 ] We decided to use only metoclopramide because domperidone, a well-known antidopaminergic antiemetic drug, had its over-the-counter status withdrawn in many European countries after the European Medicines Agency recommended restriction of its use because of potentially life-threatening cardiac effects. [ 16 ] Cisapride causes QT prolongation and may lead to torsades de pointes , and erythromycin, a macrolide antibiotic, has cardiac side effect such as QT prolongation and may result in potentially fatal cardiac arrhythmias.…”