Diarrhea metoclopramide

Administering a liter of contrast medium over a period of 1 h before the examination has proved its value. Some radiologists add 20 mg of metoclopramide (MCP,2 tablets) to the first beaker of contrast medium in order to speed up transit, which typically shortens patient preparation to 30 min. Side effects of metoclopramide - diarrhea and muscle tremor - are unlikely on single administration. 

Most common Sedation, restlessness, diarrhea (metoclopramide), agitation, central nervous system depression Less common Extrapyramidal effects (more frequent with higher doses), hypotension, neuroleptic syndrome, supraventricular tachycardia (with intravenous administration)... 

Metoclopramide can cause adverse effects such as sedation, akathisia (motor restlessness), involuntary movements, diarrhea, and dizziness. The extrapyramidal reactions, which are more common in patients < 30 years old, can be relieved by intravenous or oral diphenhydramine or benztropine (Cogentin). 

In another study, doses of 5 mg/kg (but not less) caused diarrhea and orthostatic hypotension (SEDA-9, 311) the incidence of diarrhea may well be higher than with metoclopramide (1). Other recorded effects include a sensation of bodily heat and trismus (SEDA-10, 323). 

Cisapride is structurally similar to metoclopramide, but has no dopamine receptor antagonist activity and hence no central antiemetic effect. However, because it stimulates the release of acetylcholine in the gastrointestinal tract it is effective in conditions such as reflux esophagitis and gastroparesis. During clinical trials, the most frequent unwanted effects were diarrhea (5-11%) and abdominal pain (16% with 20 mg bd). 

Granisetron and tropisetron appear to have the same safety profile as ondansetron (6). Their adverse reactions include mild rises in transaminases (up to 17%), slight headache (8-42%), transient diarrhea (2-5%), which may be followed during longer-term therapy by constipation, dizziness (5%), and dry mouth (5-17%) the incidence of xerostomia is higher than with metoclopramide. Other reported adverse effects include anorexia, paresthesia, constipation or abdominal discomfort, changes in blood pressure, fever, facial edema, leg cramps, hot flushes, and enlargement of the spleen (7). 

Adverse reactions PPIs are very well tolerated. Rarely, headache, diarrhea, constipation, nausea, and pruritus have been observed. Metoclopramide is associated with CNS side effects, especially in the elderly or in those with decreased renal function. Metoclopramide also leads to drowsiness, diarrhea, abdominal cramps, and extrapyramidal reactions. Cisapride, at high doses, is associated with QT segment prolongation. When used at the recommended doses in patients with normal renal and hepatic function, cardiac effects are rare. 

Altered intestinal motility produces diarrhea by three mechanisms reduction of contact time in the small intestine, premature emptying of the colon, and bacterial overgrowth. Chyme must be exposed to intestinal epithelium for a sufficient time period to enable normal absorption and secretion processes to occur. If this contact time decreases, diarrhea results. Intestinal resection or bypass surgery and drugs (such as metoclopramide) cause this type of diarrhea. On the other hand, an increased time of exposure allows fecal bacteria overgrowth. A characteristic small intestine diarrheal pattern is rapid, small, coupling bursts of waves. These waves are inefficient, do not allow absorption, and rapidly dump chyme into the colon. Once in the colon, chyme exceeds the colonic capability to absorb water. 

Metoclopramide (Reglan) suppresses emesis by blocking the dopamine and serotonin receptors in the CTZ. High doses can cause sedation and diarrhea. The occurrence of EPS is more prevalent in children than adults. 

Comparative studies Metoclopramide versus promethazine In a randomized, double-blind comparison of metoclopramide and promethazine in hyperemesis gravidarum, 150 women who needed intravenous antiemetic therapy were randomized to promethazine 25 mg or metoclopramide 10 mg every 8 hours for 24 hours [10 ]. The two drugs were similarly efficacious in controlling episodes of vomiting. Difficulty in sleeping, dry mouth, diarrhea, headache, episodes of palpitation, and rashes were reported in similar proportions. However, drowsiness (59% versus 84%), dizziness (34% versus 71%), dystonias (5.7% versus 19%), and therapy curtailment owing to adverse events (0% versus 9.2%) were less common with metoclopramide. 

Cardiovascular A 17-year-old man with a 3-year history of ulcer symptoms, diarrhea, and bouts of abdominal colic developed severe hypotension (50/20 mmHg) after receiving intravenous metoclopramide for acute vomiting with diarrhea [9 ]. He then developed pneumonia, rhabdomyolysis, renal tubular necrosis, and disseminated intravascular coagulation. A diagnosis of gastrinoma was made. During hormonal assessment, he received a second dose of... 

Atropine or common antiemetics can be given to provide relief from nausea and vomiting, early signs of HD intoxication (Yu et al., 2003). Excellent choices for pediatric-specific antiemetics include medications such as promethazine, metoclopramide, and ondansetron (Sidell et al., 1997). Persistent vomiting and diarrhea are later signs of systemic toxicity requiring prompt fluid replacement. 

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