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Review article: metoclopramide and tardive dyskinesia.
Aliment Pharmacol Ther 2010; 31(1):11-9AP

Abstract

BACKGROUND

Metoclopramide is a dopamine receptor antagonist which has been used for treatment of a variety of gastrointestinal symptoms over the last thirty years. In 2009, the FDA issued a black box warning regarding long-term or high-dose use of this medication because of the risk of developing tardive dyskinesia.

AIMS

To review the mechanism of action and pharmacokinetic properties of metoclopramide, the risk of metoclopramide-induced tardive dyskinesia, potential mechanisms that may alter and to summarize the clinical context for appropriate use of the drug.

METHODS

We conducted a PubMed search using the following key words and combined searches: metoclopramide, neuroleptics, tardive dyskinesia, incidence, prevalence, dopamine, receptors, pharmacokinetic, pharmacology, pharmacogenetics, DRD3 Ser9Gly polymorphism, cytochrome P450, p-glycoprotein, risk factors, gastroparesis, outcome, natural history.

RESULTS

Available data show that risk of tardive dyskinesia from metoclopramide use is likely to be <1%, much less than the estimated 1-10% risk previously suggested in national guidelines. Tardive dyskinesia may represent an idiosyncratic response to metoclopramide; pharmacogenetics affect pharmacokinetic and dopamine receptor pharmacodynamics in response to neuroleptic agents that cause similar neurological complications.

CONCLUSION

Community prevalence and pharmacogenetic mechanisms involved in metoclopramide-induced tardive dyskinesia require further study to define the benefit-risk ratio more clearly.

Authors+Show Affiliations

Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19886950

Citation

Rao, A S., and M Camilleri. "Review Article: Metoclopramide and Tardive Dyskinesia." Alimentary Pharmacology & Therapeutics, vol. 31, no. 1, 2010, pp. 11-9.
Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther. 2010;31(1):11-9.
Rao, A. S., & Camilleri, M. (2010). Review article: metoclopramide and tardive dyskinesia. Alimentary Pharmacology & Therapeutics, 31(1), pp. 11-9. doi:10.1111/j.1365-2036.2009.04189.x.
Rao AS, Camilleri M. Review Article: Metoclopramide and Tardive Dyskinesia. Aliment Pharmacol Ther. 2010;31(1):11-9. PubMed PMID: 19886950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Review article: metoclopramide and tardive dyskinesia. AU - Rao,A S, AU - Camilleri,M, PY - 2009/11/6/entrez PY - 2009/11/6/pubmed PY - 2010/5/13/medline SP - 11 EP - 9 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 31 IS - 1 N2 - BACKGROUND: Metoclopramide is a dopamine receptor antagonist which has been used for treatment of a variety of gastrointestinal symptoms over the last thirty years. In 2009, the FDA issued a black box warning regarding long-term or high-dose use of this medication because of the risk of developing tardive dyskinesia. AIMS: To review the mechanism of action and pharmacokinetic properties of metoclopramide, the risk of metoclopramide-induced tardive dyskinesia, potential mechanisms that may alter and to summarize the clinical context for appropriate use of the drug. METHODS: We conducted a PubMed search using the following key words and combined searches: metoclopramide, neuroleptics, tardive dyskinesia, incidence, prevalence, dopamine, receptors, pharmacokinetic, pharmacology, pharmacogenetics, DRD3 Ser9Gly polymorphism, cytochrome P450, p-glycoprotein, risk factors, gastroparesis, outcome, natural history. RESULTS: Available data show that risk of tardive dyskinesia from metoclopramide use is likely to be <1%, much less than the estimated 1-10% risk previously suggested in national guidelines. Tardive dyskinesia may represent an idiosyncratic response to metoclopramide; pharmacogenetics affect pharmacokinetic and dopamine receptor pharmacodynamics in response to neuroleptic agents that cause similar neurological complications. CONCLUSION: Community prevalence and pharmacogenetic mechanisms involved in metoclopramide-induced tardive dyskinesia require further study to define the benefit-risk ratio more clearly. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/19886950/Review_article:_metoclopramide_and_tardive_dyskinesia_ L2 - https://doi.org/10.1111/j.1365-2036.2009.04189.x DB - PRIME DP - Unbound Medicine ER -