Still a Place for Metoclopramide as a Prokinetic Drug in Critically Ill Patients?

Recently, regulatory agencies in North America and Europe re-evaluated the safety of metoclopramide. This resulted in recommendations and restrictions in order to minimize the risk of neurological and other adverse reactions associated with the use of metoclopramide. The side effects in non-ICU patients are as follows: 1. Neurological adverse reactions, including extrapyramidal disorders, dyskinesia, dystonia, convulsion, hypertonia and tremor. The reported occurrence of tardive dyskinesia ranges from <0.01% to 23%. High occurrence is attributed to chronic use (months to years) of approximately 30±10 mg metoclopramide a day and concerns mostly older (60 ± 22 years) women. Of an estimated 15.9-million metoclopramide prescriptions in the UK in the period 1967-1982, extrapyramidal symptoms were reported with an incidence of 0.003%. Occurrence of akathisia is related to the rate of intravenous metoclopramide administration. After a bolus injection over 2 minutes 24.7% experienced akathisia, which was reduced to 5.8% in patients receiving the same dose in a 15-minute infusion. 2. Cardiac adverse reactions, including shock, hypotension, cardiac arrest, tachycardia, bradycardia, hypertension, cardio-respiratory arrest and circulatory collapse. Evidence is solely based on case-reports.