Metoclopramide hepatitis patients

Feurle GE (1990) Arteriovenous shunting and cholestasis in hepatic hemangiomatosis associated with metoclopramide. Gastroenterology 99 258-262. Magueur E, Horgege H, Attali P, et al. (1991) Pharmacokinetics of metoclopramide in patients with liver cirrhosis. Br J Clin Pharmacol 31 185-187. Albani F, Tame MR, De Palma R, et al. (1991) Kinetics of intravenous metoclopramide in patients with hepatic cirrhosis. Eur ] Clin Pharmacol 40 423-425. 

Fever, rigors, chills, malaise headaches, myalgia Nausea, emesis Neutropenia Hepatic enzyme elevation Cutaneous—alopecia, transient, mild rashlike reaction Acetaminophen (APAP). NSAID if APAP is not effective. Meperidine for severe chills and rigors. Bedtime administration. 5-HT3 antagonist, prochlorperazine, metoclopramide, fluids Weekly complete blood count reduce dose by 30-50% Liver function tests (LFTs) weekly withhold treatment until LFTs normalize restart at 30-50% dose reduction reversible on dose reduction or cessation. Interferon is contraindicated in patients with psoriasis because exacerbation of psoriasis has been noted during IFN therapy. 

Renal/Hepatic function impairment Because metoclopramide is excreted principally through the kidneys, in those patients whose Ccr is less than 40 mL/min, initiate therapy at approximately >2 the recommended dosage. Depending on clinical efficacy and safety considerations, the dosage may be increased or decreased as appropriate. 

Metoclopramide undergoes minimal hepatic metabolism, except for simple conjugation. Its safe use has been described in patients with advanced liver disease whose renal function was normal. 

Metoclopramide should be avoided where possible, as it may cause cerebral irritation. If metoclopramide were to be used the dose should be reduced to 50% of normal, because of reduced hepatic clearance and concomitantly reduced renal clearance. The dose may also require further reduction according to renal function. As this patient is currently taking spironolactone, metoclopramide should be avoided as it may reduce the diuretic effect. 

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. 

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