Review of a new gastrointestinal drug—metoclopramide

Ponte, Charles D.; Nappi, Jean M.

doi:10.1093/ajhp/38.6.829

Cited by 22 publications

(14 citation statements)

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“…30,31 One cardiac arrest case occurred upon dopamine discontinuation. 16 The effect may be the result of increased release and levels 32–37 of acetyl-choline producing cholinergic-induced brady-dysrrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Metoclopramide-Induced Cardiac Arrest

Rumore

Lee

Wang

et al. 2011

Clinics and Practice

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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.

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Section: Discussionmentioning

confidence: 99%

Metoclopramide-Induced Cardiac Arrest

Rumore

Lee

Wang

et al. 2011

Clinics and Practice

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“…The onset of action of intramuscular metoclopramide is 5 to 15 min, with a peak serum concentration within 2 hr, and a half-life of 4 hr. 16 Categorical variables were compared using the chisquare or Fisher's exact test. Continuous variables were compared with the Student's t-test.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of metoclopramide as an adjunct to duodenal placement of small‐bore feeding tubes: a randomized, placebo‐controlled, double‐blind study

Kittinger¹,

Sandler²,

Heizer³

1987

J Parenter Enteral Nutr

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We examined whether metoclopramide would improve the success rate of transpyloric intubation of a weighted Corpak feeding tube when fluoroscopic guidance is not used. Seventy patients were randomized in a prospective, double-blind fashion to receive either placebo (n = 35) or metoclopramide, 10 mg (n = 35) parenterally, administered immediately after the feeding tube was inserted. Tube location was determined independently by two observers who examined radiographs obtained after barium was instilled via the tube. There was no significant increase in the success rate of duodenal intubation in the total group following metoclopramide, 60%, compared to placebo, 49%. However, analysis of subgroups among the placebo-treated patients revealed that diabetes mellitus, but not other medical conditions, decreased the success rate for duodenal intubation, 20 vs 60% (p less than 0.05). Among diabetic patients, metoclopramide resulted in a significant increase in duodenal placement compared to placebo (p less than 0.05). We conclude that parenteral metoclopramide significantly increases the frequency of transpyloric intubation with small feeding tubes without fluoroscopic guidance in diabetic patients but not in nondiabetic patients.

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“…2 In addition, metoclopramide is a potent anti-emetic because it antagonizes dopamine receptors in the chemoreceptor trigger zone in the central nervous system. 3 Metoclopramide is the only drug approved by the Food and Drug Administration (FDA) for the management of symptoms of diabetic gastroparesis. 4 A nasal spray formulation of metoclopramide (EVK-001) has been developed to deliver metoclopramide systemically using intranasal (IN) administration as an alternative to oral formulations that require gastrointestinal (GI) absorption.…”

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confidence: 99%