Cardiovascular adverse effects of metoclopramide: Review of literature

Introduction: Articles pertaining to reports and clinical or pharmacological research for cardiovascular adverse effects of metoclopramide were identified via a search of MEDLINE (1966­February 2012), SCOPUS, and Google Scholar. Objective: To review the reports in literature of patients receiving metoclopramide who sufferred from cardiac arrest, bradycardia, total heart block, acute hypotension, supraventricular tachycardia, circulatory collapse, QT prolongation, Torsade de Pointes, ST depression, and congestive heart failure. Discussion: In most cases the reactions occurred immediately after administration of metoclopramide, were associated with normal doses administered via intravenous or central lines, and resolved. Rechallenge occurred in several cases. The likelihood of these events occurring and the mechanism by which metoclopramide affects the cardiovascular system is unclear, however, it has been shown to have a direct effect on the heart, block presynaptic autoreceptors and enhance catecholamine release, enhance cholinergic neurotransmission and cause 5­HT3 receptor blockade and 5­HT4 receptor antagonism. Conclusion: Due to cardiovascular risks associated with the use of IV metoclopramide, recommendations are to monitor patients and report these events.