Tachycardia 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)... 

SK F 85174 was chosen for more detailed study (31). In anesthetized dogs, tachycardia Induced by cardiac accelerator nerve stimulation was inhibited by intravenous SK F 85174 (EDjg, 42 Ug/kg) which effect was antagonized by metoclopramide and 1-sulpiride. In anesthetized rats (normotensive, spontaneously hypertensive, DOCA-salt hypertensive) SK F 85174 decreased both blood pressure and heart rate. The results suggested that SK F 85174 has presynaptic dopaminergic activity and may be useful in the treatment of angina and hypertension (31). 

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. 

Complete heart block (SEDA-12, 939) (1) and supraventricular tachycardia (2), presumably due to a vagolytic effect, have been described with metoclopramide. If there are predisposing conditions, heart failure can be precipitated (SEDA-16, 418). In one study in which 56 patients were treated with metoclopramide, a single case of second-degree atrioventricular heart block was observed (SEDA-20, 316). 

Bevacqua BK. Supraventricular tachycardia associated with postpartum metoclopramide administration. Anesthesiology 1988 68(l) 124-5. 

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. 

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 ]. 

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