Oculogyric crisis in a patient taking metoclopramide

Abstract

Oculogyric crisis is an acute dystonic reaction of the ocular muscles characterized by bilateral dystonic elevation of visual gaze lasting from seconds to hours. This reaction is most commonly explained as an adverse reaction to drugs such as antiemetics, antipsychotics, antidepressants, antiepileptics, and antimalarials. Although the incidence of metoclopramide-induced acute dystonic reactions has been reported as 25% in children, there have been few published cases on oculogyric crisis in general. It is important to be able to recognize this ocular side effect because, without a thorough patient history, symptoms can be confused with other diseases such as versive seizures, paroxysmal tonic upward gaze, and encephalopathy. In this paper, we report a case of oculogyric crisis induced by metoclopramide.

Oculogyric crises: A review of phenomenology, etiology, pathogenesis, and treatment

“…Of medications associated with OGC, DRBAs have been the most extensively implicated. These include typical antipsychotics such as haloperidol and phenothiazines, atypical antipsychotics including sulpiride, risperidone, ziprasidone, olanzapine, aripiprazole, and clozapine, and antiemetics with action at dopamine receptors (e.g., metoclopramide) . OGC have been repeatedly described after exposure to the antiepileptic drugs (AEDs), carbamazepine (CBZ) and lamotrigine (LTG) …”

Acute Dystonic Reaction in a 14-Year-Old Boy after Accidental Overuse of Nasal Metoclopramide

“…Acute dystonic reaction is an acute neurological condition, commonly seen in the emergency department that is characterized by involuntary muscle contractions that may manifest as torticollis, opisthotonus, dysarthria and/or oculogyric crisis [1]. Metoclopramide, one of the most commonly prescribed anti-emetics, may cause acute dystonic reactions at any age, most often in children and adolescents [2]. Clinical symptoms can develop within hours or even days after the administration of the drug, and can be misdiagnosed as tetanus, hypocalcemia, epileptic seizures and even meningoencephalitis [1].…”

Perfil de uso y seguridad de metoclopramida en pacientes pediátricos atendidos en un hospital de segundo nivel

“…Al evaluar las variables que se relacionan con presentar una reacción adversa en niños, se encontró que tener un peso menor a 10 kg y recibir tres dosis al día se asociaron con dicho efecto adverso, tal como se ha establecido en otros estudios en los que los efectos adversos de la metoclopramida son más frecuentes en quienes reciben altas dosis, en los extremos de la vida, o en pacientes con antecedentes familiares de reacciones adversas al medicamento (33)(34)(35).…”