Hypotension metoclopramide

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)... 

Prochlorperazine (Compazine, and others) can be effective for prevention of vomiting due to cancer chemotherapy, but is generally less so than dexamethasone or metoclopramide. Phenothiazines can cause orthostatic hypotension, sedation, dystonic reactions, and akathisia. 

Alizapride is a substituted benzamide related to some neuroleptic drugs. In one study alizapride, in doses that were less effective than normal doses of metoclopramide, was equally likely to cause extrapyramidal effects and more likely to cause hypotension (SED-12, 939) (SEDA-17, 413). 

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). 

In a double-blind, randomized, crossover comparison of batanopride and metoclopramide in 21 chemotherapy-naive patients who received cisplatin at least 70mg/m, the study was terminated when hypotension was observed after infusion of batanopride at other institutions testing similar drug schedules, although the authors themselves saw no cases of hypotension after treatment with batanopride (3). However, they did note asymptomatic prolongation of the QTc interval, PR interval, and QRS complex. 

The effect of metoclopramide on oral morphine absorption is an established interaction that can be usefully exploited in anaesthetic practice, but the increased sedation may also represent a problem if the morphine is being given long-term. The morphine-sparing effect of droperidol is also a useful interaction, but the increased sedation and possible respiratory depression and hypotension should be borne in mind. One manufacturer of fentanyl specifically warns that concurrent use with droperidol can result in a higher incidence of hypotension. ... 

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... 

GERD may be due to an extremely hypotensive sphincter, and this was the rationale for the use of metoclopramide in the past. But it is now appreciated that this abnormality is rare and that most GERD is probably due to spontaneous but excessively prolonged (30 to 60 seconds) relaxation of the LES. The issue of transient LES relaxation (TLESR) and its role in GERD is an exciting area of pathophysiology and potentially important therapeutic development. 

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