Use of metoclopramide associated with the risk of developing extrapyramidal symptoms: a literature review

Abstract

Background: Parkinsonism is an extrapyramidal syndrome characterized by the presence of tremor, akinesia and stiffness. Metoclopramide is a substance with antiemetic properties, and the mechanism of action is an antagonism of the dopamine D2 receptor. Thus, it presents adverse effects, such as dyskinesia, dystonia, hypertonia and tremor. Accordingly, studies associate the use of metoclopramide with an increased risk of developing extrapyramidal effects. Objectives: The aimed is describe the association between the use of metoclopramide and the risk of developing extrapyramidal symptoms. Methods: A literature review was carried out based on articles from the PubMed database, totaling 10 articles. The keywords used for the selection of articles were: metoclopramide, extrapyramidal and parkinsonism. Results: A case study noted that the use of metoclopramide leads to a dopamine deficiency, which may be involved in the etiology of parkinsonism, as a patient already diagnosed with Parkinson’s disease developed an exacerbation after using metoclopramide. Another study showed that the use of metoclopramide in the elderly population was considered a risk factor for adverse effects such as involuntary movements. A cohort study described a positive association between the use of oral metoclopramide and an increased risk of developing parkinsonism, considered as an important side effect in high-exposure, older users and with other morbidities. Conclusions: Therefore, it was evident that an association between metoclopramide and the development of extrapyramidal symptoms is strongly indicated by the studies analyzed, which suggests caution in the prescription of this pharmacological class.