Neurological Side Effects Associated with Unnecessary Use of Metoclopramide in Children

Abstract

AA Al Zaben, AS Al Herbish, Neurological Side Effects Associated with Unnecessary Use of Metoclopramide in Children. 1995; 15(2): 183-184 Incidence of side effects of metoclopramide is 20%.1 Neurological symptoms such as oculogyric crisis and involuntary contractions of the eye muscles leading to upward conjugate gaze occur in about 1% of patients. 2Children and young adults are more prone to develop these symptoms, even after a single dose. 3,4 Despite the fact that these effects disappear spontaneously and completely after discontinuation of this treatment, they create unnecessary anxiety for the patient, parents and health care personnel. This problem would not have emerged without the uncontrolled, and most of the time unnecessary, prescription of metoclopramide to young children. In this study, over a one-year period, we analyzed the clinical data of 24 children who presented with these manifestations after being prescribed metoclopramide for an acute illness. Material and MethodsClinical data and hospital course of children presenting over a one-year period (starting July 1991) to the emergency room of the Pediatric Department of the Riyadh Medical Complex with neurological symptoms due to metoclopramide (primperan or plasil) were analyzed. The number of admissions to this emergency unit was 30 to 50 children per day with various acute pediatric problems. Age, weight, indicating symptoms for prescribing metoclopramide, dose given, frequency and route of administration were all recorded. The specific neurological symptom and/or sign, e.g., oculogyric crisis defined as involuntary contractions of the eye muscles resulting in upward conjugate gaze, dystonia, drowsiness, etc. was elicited at presentation and its course thereafter was followed. Some children were given diazepam to abort or lessen these symptoms and the rest resolved spontaneously.