Neurotoxic Effects of Pharmaceutical Agents V: Miscellaneous Agents

A Single Dose of Metoclopramide Associated with Extrapyramidal Symptoms in a Child: A Case Report

“…Metoclopramide, a procainamide derivative, a fruitful anesthetic adjuvant, is the most commonly used selective D2 receptor antagonist used for antiemetic prophylaxis, primarily for PONV and chemotherapy associated with low emetogenic risk [8]. Its antiemetic effects are as a result of antagonizing central and peripheral dopamine receptors [9]. Metoclopramide can precipitate extrapyramidal symptoms (movements disorder or parkinsonism) [9].…”

“…Its antiemetic effects are as a result of antagonizing central and peripheral dopamine receptors [9]. Metoclopramide can precipitate extrapyramidal symptoms (movements disorder or parkinsonism) [9]. The underlying mechanism that causes extrapyramidal symptoms is not yet clear but a striatal dopamine D2 receptor blockade causing a dopamine-cholinergic imbalance is believe to be the fundamental cause [3,10].…”

“…Subsequently to metoclopramide administration, symptoms can appear within 24-72 hours [9]. The incidence of these adverse effects has greater risk in people at the extreme age spectrum, 6 times higher in children than adults, and it can be up to 25% even at the recommended dose and are usually in form of involuntary limb movement, facial grimacing, torticollis, trismus, and rarely in severe form such as neuroleptic malignant syndrome [7,9,11].…”