Metoclopramide nervous system

The adverse reactions associated widi metoclopramide are usually mild. Higher doses or prolonged administration may produce central nervous system (CNS) symptoms, such as drowsiness, dizziness, Parkinson-like symptoms (tremor, mask-like facial expression, muscle rigidity), depression, facial grimacing, motor restlessness, and involuntary movements of die eyes, face, or limbs. Dexpandienol administration may cause itching, difficulty breadiing, and urticaria... 

A PPI may be warranted in patients older than 60 years of age.29 Proton pump inhibitors are the most useful option because they have superior efficacy and are dosed once daily. Elderly patients maybe sensitive to the central nervous system effects of metoclopramide and H2RAs. 

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)... 

Drugs and chemicals are known to cause activated interaction. The depressant action of opioid drugs is enhanced by drugs acting on the central nervous system (CNS) such as alcohol, anesthetics, anxiolytics, hypnotics, tricyclic antidepressants, and antipsychotics. Concomitant administration of opioid analgesics and monoamine oxidase inhibitors (MAOIs) should be avoided, or extra care should be taken if such a therapy is inevitable. Fatal reactions are reported when treated along with selegiline. Interactions also are reported with cyclizine, cimetidine, mexiletine, cisapride, metoclopramide, or domperidone. 

Metoclopramide antagonizes D2 receptors in both the chemoreceptor trigger zone and central nervous system (as it crosses the blood-brain barrier). 

The antiemetic and antivertigo dru are contraindicated in patients with known hypersensitivity to these dru, diose in a coma, or those with severe central nervous system (CNS) depression. In general, these dni are not recommended during pregnancy, lactation, or for uncomplicated vomiting in young children. Metoclopramide is contraindicated in patients with a seizure disorder, breast cancer, pheochromocytoma, or gastrointestinal obstruction. Prochlorperazine is contraindicated in patients with bone marrow depression, blood dyscrasia, Fbrkinson s... 

Nervous system Severe, partially irreversible parkinsonism has been attributed to metoclopramide [13 ]. 

Nervous system A 58-year-old woman who was taking mirtazapine and metoclopra-mide started to take levofloxacin 1 day later she had an episode of loss of consciousness associated with urinary incontinence and on the following day two tonic-clonic seizures [60 ]. Levofloxacin and mirtazapine were withdrawn and the seizure activity stopped. No other cause for her seizures was found. The authors concluded that levofloxacin is epileptogenic and had also, by inhibiting CYP1A2, increased the serum concentrations of mirtazapine and metoclopramide, drugs that also have epileptogenic effects. 

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 ]. 

Nervous system A 26-year-old woman undergoing emergency cesarean delivery under spinal anesthesia with bupivacaine 10 mg was pre-medicated with intravenous ranitidine 50 mg and metoclopramide 10 mg, and received intramuscular diclofenac for postoperative analgesia [32 ]. Starting at 12 hours postoperatively she was given intravenous ondansetron 6 mg every 12 hours for nausea and vomiting. About 2 hours after the first dose she developed a severe headache, which persisted for over 90 hours and was characterized by aggravation of symptoms in coincidence with doses of ondansetron. The headache resolved completely a few hours after ondansetron withdrawal. 

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