Metoclopramide (Reglan)

The Drug

Metoclopramide is an antiemetic and gastroprokinetic agent used to facilitate gastric emptying, as well as to treat nausea and vomiting.  Though marketed under other trade names, metoclopramide is commonly known as Reglan, and is formulated in tablet, disintegrating tablet, oral solution, and injection form.

The Controversy

Metoclopramide is the most common cause of drug-induced tardive dyskinesia, a serious neurological disorder characterized by Parkinsonian symptoms such as involuntary and repetitive movements.  Such movements are most commonly manifested by lip smacking and pursing, chewing, grimacing, rapid eye movements and blinking, impaired finger movement, and tongue protrusions.  Unfortunately, evidence suggests that these effects may be permanent and irreversible[1,2].

The risk of tardive dyskinesia increases with prolonged therapy and at high doses.  Moreover, evidence suggests that elderly populations are particularly at risk, especially amongst females.  In response to these risks, the FDA issued a black box warning for the drug in 2009, indicating among other things that its use should not exceed 4-12 weeks.  Despite these warnings, a recent FDA study showed that 20% of all patients, and 32% of elderly patients, were taking metoclopramine for more than three months at a time[3].

Metoclopramine has exhibited additional neurological and psychiatric symptoms such as depression, suicidal ideation, suicide, neuroleptic malignant syndrome, and tardive tremors[4,5,6,7].

Symptoms

Deleterious effects associated with metoclopramide include:

  • Repetitive and involuntary movements
  • Depression
  • Tremors
  • Impaired movement
  • Suicidal ideation

If you or a loved one has been diagnosed with tardive dyskinesia and have used Reglan/metoclopramide in the past, please feel free to contact Freese & Goss today.  Attorneys are available by phone, e-mail, or by clicking here.

[1] Jeste D, Caligiuri M.  Tardive Dyskinesia.  Schizophrenia Bulletin, 1993, 19(2):303-15.

[2] Shaffer D, Butterfield M, Pamer C, Mackey A.  Tardive Dyskinesia Risks and Metoclopramide Use Before and After U.S. Market Withdrawal of Cisapride.  Journal of the American  Pharmacists Association (Wash DC), 2004, 44(6):661-5.

[3] Sigal Kaplan, Metoclopramide: Drug Use Data Review,  Department of Health and Human Services,  June 10, 2005.

[4] Anfinson T.  Akathisia, Panic, Agoraphobia, and Major Depression Following Brief Exposure to Metoclopramide.  Psychopharmacology Bulletin, 2002, 36(1):82-93.

[5] Friend K, Young R.  Late-Onset Major Depression with Delusions after Metoclopramide Treatment.  American Journal of Geriatric Psychiatry, 1997,  5(1):79-82.

[6] Lu M, Pan J, Teng H, Su K, Shen W.  Metoclopromide-Induced Supersensitivity Psychosis.  Annals of Pharmacotherapy, 2002, 36(9):1387-90.

[7] Tarsy D, Indorf G.  Tardive Tremor Due to Metoclopramide.  Movement Disorders, 2002, 17(3):620-1.

 

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