Rate of metoclopramide infusion affects the severity and incidence of akathisia

Abstract

Objective: To investigate the effect of the rate of metoclopramide infusion on akathisia incidence, severity, onset of symptoms, and duration in patients with headache, and/or nausea/vomiting in the emergency department (ED) setting. Methods: Prospective, double blind, randomised clinical study comparing two rates of intravenous infusion of metoclopramide over a period of six months at a tertiary university hospital ED. Results: A total of 300 patients presented to the ED met the inclusion criteria: 151 (50.3%) with nausea/ vomiting, 108 (36%) with headache, and 41 (13.7%) with headache and nausea/vomiting. Of these, 154 patients (51.3%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 minutes plus placebo (SIG group) and 146 patients were given 10 mg metoclopramide intravenous bolus infusion over two minutes plus placebo (BIG group). Nine of the 154 patients in the SIG group (5.8%) had akathisia compared with 36/146 patients (24.7%) in the BIG group (p,0.001, OR 5.273, 95% CI 2.43 to 11.403). Severe akathisia were observed in 13/45 (28.8%). The incidence of severe akathisia was significantly higher in the BIG group (30.5%; 11/36) than in the SIG group (22.2%; 2/9), p = 0.009. Metoclopramide successfully relieved the presenting symptom(s) of 137/146 (90.8%) and 139/154 (90.2%) patients in the BIG and SIG groups, respectively. Conclusions: This study suggests that slowing the rate of infusion of metoclopramide is an effective strategy for reducing the incidence of akathisia in patients with headache, and/or nausea/vomiting in ED.

Antiemetic Therapy for Nausea and Vomiting in the Emergency Department

“…of metoclopramide does not result in additional efficacy in the ED setting (10). Also, metoclopramide given as an infusion over 15 min is less likely to cause akathisia than if the same dose is given as a bolus over 2 min (5.8% vs. 24.7%, respectively; p Ͻ 0.001) (43). This observation is replicated in another study in patients with headache that reported a 78% relative risk reduction of akathisia with an infusion over 15 min (44).…”

Metoclopramide and Extrapyramidal Symptoms: A Case Report

“…3,8,9 A recent study found that when metoclopramide was administered over 15 minutes, the severity and incidence of metoclopramide-induced akathisia was reduced compared with administration over two minutes. 19 If metoclopramide is administered rapidly, the patient may have anxiety, restlessness, and/or drowsiness. During and after administration, the patient should have vital signs and mental status monitored.…”

Acatisia inducida por fármacos no psicotrópicos: a propósito de un caso asociado a metoclopramida.

“…Se ha reportado que la incidencia y severidad de acatisia está relacionada a la velocidad de infusión de la metoclopramida parenteral (16,17). Tres estudios clínicos aleatorios y doble ciego concluyeron que infusiones lentas de metoclopramida (por alrededor de quince minutos) eran una estrategia efectiva para reducir la incidencia y severidad de la acatisia (1,17,18). En nuestro caso la administración de metoclopramida se dio en infusiones rápidas lo que aumentó el riesgo de aparición de acatisia.…”

“…La Administración de Alimentos y Medicamentos de los Estados Unidos de América ha limitado sus indicaciones a la gastroparesia diabética, al reflujo gastroesofágico, a procedimientos de radiografía gastrointestinal e intubación intestinal, y a Rev Neuropsiquiatr 78 (1), 2015.…”

“…náuseas y vómitos luego de cirugía o quimioterapia (1). La metoclopramida está incluida actualmente dentro de la lista de medicamentos esenciales de la Organización Mundial de la Salud.…”