Metoclopramide-Induced Cardiac Arrest

Abstract

The authors report a case of cardiac arrest in a patient receiving intravenous (IV) metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV) injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG) revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT) associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs) related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s) underlying metoclopramide's cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and reporting of bradydysrrhythmias and cardiac arrest in patients receiving metoclopramide.

Domperidone, cytochrome P450 3A4 isoenzyme inhibitors and ventricular arrhythmia: a nationwide case-crossover study

“…However, in our study, there was no difference between domperidone and metoclopramide in the odds of ventricular arrhythmia (aOR 1.06, 95%CI [0.91–1.23]). Our findings thus echo previous studies in which metoclopramide was associated with ventricular arrhythmia . As with domperidone, clinical attention to QT prolongation and pro‐arrhythmic events is warranted when metoclopramide is administered.…”

“…Our findings thus echo previous studies in which metoclopramide was associated with ventricular arrhythmia. [24][25][26][27] As with domperidone, clinical attention to QT prolongation and proarrhythmic events is warranted when metoclopramide is administered.…”

The efficacy and safety of itopride in feeding intolerance of critically ill patients receiving enteral nutrition: a randomized, double-blind study

“…On the other hand, after the one-week therapy, there were clinically related changes in the ECG of two patients of the metoclopramide group, particularly prolongation of QT intervals. In similarity to the findings of the current study, other studies and case reports have reported cardiotoxic effects caused by metoclopramide especially with higher doses and with long-term use [44,45].…”

When crizotinib-induced bradycardia becomes symptomatic: role of concomitant drugs

“…The European Committee also recommended to use metoclopramide with caution in patients with cardiac conduction disturbances, bradycardia and in those taking other drugs known to prolong the QT interval [10]. In fact, cases of metoclopramide-related cardiovascular adverse effects have been reported in the literature [11].…”