The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

Metoclopramide-Induced Encephalopathy in Parkinson Disease

Authors: Bradley J. Robottom, MD, Lisa M. Shulman, MD, Karen E. Anderson, MD, William J. Weiner, MD

Abstract

A case of prolonged encephalopathy and worsened parkinsonism in a Parkinson disease patient exposed to a short course of metoclopramide is described. Parkinson disease (PD) is the second most common neurodegenerative disease in the United States. Because of the increased susceptibility to adverse drug effects, PD presents a special challenge to physicians. Anti-emetic drugs such as metoclopramide are widely used and may be particularly deleterious to PD patients due to blockade of dopamine receptors.


Key Points


* The clinical spectrum of metoclopramide's adverse effects is broad, and the range of neuropsychiatric adverse effects is underappreciated.


* Patients with Parkinson disease are particularly vulnerable to adverse effects of dopamine receptor blockers.


* Increased knowledge of metoclopramide's adverse effects should lead to safer prescribing practices.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Baxter Healthcare Corporation. Reglan [Package Insert.] Deerfield, IL, Baxter Healthcare Corporation, 2003.
 
2.Sirota RA, Kimmel PL, Trichtinger MD, et al. Metoclopramide-induced parkinsonism in hemodialysis patients. Report of two cases. Arch Intern Med 1986;146:2070–2071.
 
3.Indo T, Ando K. Metoclopramide-induced parkinsonism. Clinical characteristics of ten cases. Arch Neurol 1982;39:494–496.
 
4.Grimes JD, Hassan MN, Preston DN. Adverse neurologic effects of metoclopramide. Can Med Assoc J 1982;126:23–25.
 
5.Miller LG, Jankovic J. Metoclopramide-induced movement disorders. Clinical findings with a review of the literature. Arch Intern Med 1989;149:2486–2492.
 
6.Mazza A, Ruffatti S, Pessina AC, et al. Tetanus-like syndrome secondary to metoclopramide administration. Ann Ital Med Int 2000;15:301–302.
 
7.Sewell DD, Jeste DV. Metoclopramide-associated tardive dyskinesia. An analysis of 67 cases. Arch Fam Med 1992;1:271–278.
 
8.Dubow JS, Leikin J, Rezak M. Acute chorea associated with metoclopramide use. Am J Ther 2006;13:543–544.
 
9.Anfinson TJ. Akathisia, panic, agoraphobia, and major depression following brief exposure to metoclopramide. Psychopharmacol Bull 2002;36:82–93.
 
10.Hyser CL, Drake ME Jr. Myoclonus induced by metoclopramide therapy. Arch Intern Med 1983;143:2201–2202.
 
11.Weddington WW Jr, Banner A. Organic affective syndrome associated with metoclopramide: case report. J Clin Psychiatry 1986;47:208–209.
 
12.Fishbain DA, Rogers A. Delirium secondary to metoclopramide hydrochloride. J Clin Psychopharmacol 1987;7:281–282.
 
13.Cunningham D, Dicato M, Verweij J, et al. Optimum anti-emetic therapy for cisplatin induced emesis over repeat courses: ondansetron plus dexamethasone compared with metoclopramide, dexamethasone, plus lorazepam. Ann Oncol 1996;7:277–282.
 
14.Esper CD, Factor SA. Failure of recognition of drug-induced parkinsonism in the elderly. Mov Disord 2008;23:401–404.
 
15.Feely J, Coakley D. Altered pharmacodynamics in the elderly. Clin Geriatr Med 1990;6:269–283.
 
16.Adams C. Metoclopramide and depression. Ann Intern Med 1985;103:960.
 
17.Friend K, Young R. Late-onset major depression with delusions after metoclopramide treatment. Am J Geriatr Psychiatry 1997;5:79–82.
 
18.Masters JC, O'Grady M. Adverse reactions to metoclopramide (reglan) presenting as depression in a bone marrow transplant patient. Medsurg Nurs 1995;4:481–485.
 
19.Patterson D, Abell T, Rothstein R, et al. A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol 1999;94:1230–1234.
 
20.Tornetta FJ. Clinical studies with the new antiemetic, metoclopramide. Anesth Analg 1969;48:198–204.
 
21.Eggers C. [Non-delirious toxic psychoses in children.] Z Kinderheilkd 1975;119:71–86 [in German].
 
22.Nieoullon A. Dopamine and the regulation of cognition and attention. Prog Neurobiol 2002;67:53–83.
 
23.Kulisevsky J. Role of dopamine in learning and memory: implications for the treatment of cognitive dysfunction in patients with Parkinson's disease. Drugs Aging 2000;16:365–379.
 
24.Mehta MA, Sahakian BJ, McKenna PJ, et al. Systemic sulpiride in young adult volunteers simulates the profile of cognitive deficits in Parkinson's disease. Psychopharmacology (Berl) 1999;146:162–174.
 
25.Savitz J, Solms M, Ramesar R. The molecular genetics of cognition: dopamine, COMT, and BDNF. Genes Brain Behav 2006;5:311–328.