Metoclopramide hypertension with

When stimulation of Gl motility might be dangerous (eg, in the presence of Gl hemorrhage, mechanical obstruction, or perforation) pheochromocytoma (the drug may cause a hypertensive crisis, probably because of release of catecholamines from the tumor control such crises with phentolamine) sensitivity or intolerance to metoclopramide epileptics or patients receiving drugs likely to cause extrapyramidal reactions (the frequency and severity of seizures or extrapyramidal reactions may be increased). 

A 59-year-old woman with no history of cardiac problems, except for hypertension, who was taking amlo-dipine 5 mg qds, cyclobenzaprine 10 mg qds, and co-triamterzide 37.5 + 25 mg qds, and who had a QTC interval of 497 ms, was given intravenous droperidol 0.625 mg and metoclopramide 10 mg 45 minutes before surgery. About 1.75 hours after surgery she developed a polymorphic ventricular tachycardia with findings consistent with torsade de pointes, which resolved with defibrillation. 

A hypertensive crisis has been precipitated by metoclopramide in patients with pheochromocjToma (4). 

A 32-year-old woman with depression who had been taking venlafaxine 225 mg daily in divided doses for 3 years was admitted to hospital after a fall. She developed a movement disorder and a period of unresponsiveness after being given a 10-mg intravenous dose of metoclopramide. After a second dose of metoclopramide the symptoms recurred and were associated with confusion, agitation, fever, diaphoresis, tachypnoea, tachycardia, and hypertension. The symptoms were consistent with the serotonin syndrome, with a serious extrapyramidal movement disorder. The venlafaxine was withheld and she was given diazepam. The symptoms resolved over the next two days, after which she continued to take venlafaxine. Information seems to be limited to this report, and the general significance of this interaction is unclear. 

A 56-year-old man with hypertension suffered a 62% total body surface area burn (day 0) and on day 4 developed atrial fibrillation with a rapid ventricular rate, which was treated with amiodarone and digoxin. After pyloroplasty for a bleeding ulcer on day 20, he developed a postoperative ileus and was given metoclopramide 20 mg intravenously every 6 hours. Beginning on day 54, he started to have episodes of bradycardia and asystole. Some episodes required atropine and others resolved spontaneously. Some converted initially to a junctional rhythm, but all ultimately reverted to sinus tachycardia. Digoxin and metoclopramide were withdrawn and several hours later the bradydysrhythmias stopped. 

An 86-year-old man with a history of hypertension, hypothyroidism, and gastroesophageal reflux developed symptoms of cardiac failure while taking Usinopril, levothyroxine, and metoclopramide 10 mg qds [10 ]. Furosemide administration was associated with renal impairment, and followed by QT interval prolongation, which evolved into torsade de pointes. After successful defibrillation, the QT interval prolongation persisted and resolved only after metoclopramide withdrawal. 

Nervous system A 40-year-old man was treated with metoclopramide by intravenous infusion of 10 mg over 5 minutes and famotidine 20 mg as premedication for elective endoscopic sinus surgery. About 10-15 minutes after metoclopramide administration, he developed agitation, tachycardia, and hypertension, which resolved after treatment with oxygen 2 liters/minute and intravenous diphenhydramine 25 mg [ll ]. 

A 79-year-old man underwent colonic resection for bowel obstruction. He had a history of Parkinson s disease and associated dementia, hypertension, type-2 diabetes and occasional constipation. His current medications included carbidopa-levodopa extended release, lisinopril, furosemide, isophane insulin and polyethylene glycol (as needed for constipation). He was treated with metoclopramide (10 mg i.v., every 6 h) for stimulating gastric motility. After receiving the first three doses of metoclopramide, the patient developed mental deterioration until he became xmre-sponsive, and could not be aroused. An electroencephalogram displayed a pattern of diffuse slowing of the background rhythm, which was consistent with acute metabolic encephalopathy. Metoclopramide was discontinued, and... 

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