Severe parkinsonism due to metoclopramide: the importance of early recognition].

Maurice W J de Ronde, Hylke Jan Kingma, Alexander G Munts

Kennemer Gasthuis, afd. Neurologie, Haarlem, the Netherlands. mwjderonde@gmail.com

Nederlands tijdschrift voor geneeskunde 2013

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In this article, we present 3 women aged 73, 85 and 88 years who developed metoclopramide-induced parkinsonism. Shortly after starting metoclopramide, bradykinesia and rigidity developed in all 3 patients; tremor and postural instability in 2 of them. We discontinued the metoclopramide after 3-6 months; 2 of the patients had fully recovered 4-6 months later. The 3rd patient died from pneumonia, however, 2 months after discontinuation. Metoclopramide, a dopamine D2-antagonist, is a frequently prescribed anti-emetic drug; however, evidence of its efficacy is limited. In many patients, domperidone, another dopamine D2-antagonist, seems to be a better alternative. Movement disorders due to domperidone are uncommon, presumably because it does not cross the blood-brain barrier. It is likely that metoclopramide-induced parkinsonism is not uncommon; however, it is under-recognized. Risk factors are female sex, advanced age, diabetes mellitus and polypharmacy. Follow-up on patients using metoclopramide is advised.

Citation

Maurice W J de Ronde, Hylke Jan Kingma, Alexander G Munts. Severe parkinsonism due to metoclopramide: the importance of early recognition]. Nederlands tijdschrift voor geneeskunde. 2013;157(26):A6037