Metoclopramide-induced cardiac arrest.

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Metoclopramide, a dopamine receptor antagonist, is commonly used for gastrointestinal motility disorders.
• Adverse drug reactions (ADRs) associated with metoclopramide are not fully characterized, particularly severe cardiac events.
• The potential for metoclopramide to induce cardiac arrest is not widely recognized or listed in its prescribing information.

Purpose of the Study:

• To report a case of cardiac arrest following intravenous metoclopramide administration.
• To review existing literature on metoclopramide-associated cardiac events.
• To raise awareness among clinicians regarding potential severe cardiac ADRs of metoclopramide.

Main Methods:

• Case report of a patient experiencing cardiac arrest after IV metoclopramide.
• Literature search for similar cases of cardiac arrest, bradycardia, and arrhythmias associated with metoclopramide.
• Analysis of the patient's clinical presentation, ECG findings, and response to treatment.
• Assessment of the potential causality using the Naranjo scale.

Main Results:

• A 62-year-old female developed cardiac arrest, including bradycardia and asystole, within one minute of receiving IV metoclopramide.
• The patient experienced subsequent cardiac dysrhythmias, including supraventricular tachycardia and atrial fibrillation.
• Literature review identified seven previous cases of cardiac arrest and one of sinus arrest linked to metoclopramide.
• Coronary artery disease was identified as a potential risk factor in this case; the reaction is not dose-dependent but may be route-related (IV).

Conclusions:

• Intravenous metoclopramide administration can precipitate severe cardiac events, including cardiac arrest.
• The prescribing information for metoclopramide does not adequately warn of this rare but serious ADR.
• Clinicians must exercise vigilance, monitor patients closely for cardiac dysrhythmias, and report suspected cases of metoclopramide-induced cardiac arrest.