Extrapyramidal reactions to metoclopramide and prochlorperazine

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Neuroscience

Background:

• Metoclopramide and prochlorperazine are commonly prescribed medications.
• Extrapyramidal events are known side effects of antipsychotic and prokinetic drugs.
• Understanding the incidence of these events in primary care is crucial for patient safety.

Purpose of the Study:

• To prospectively investigate the incidence of extrapyramidal events associated with first-time prescriptions of metoclopramide and prochlorperazine.
• To identify patient demographics at higher risk for specific extrapyramidal reactions.

Main Methods:

• Prospective investigation of patients receiving first prescriptions for metoclopramide (n=2557) and prochlorperazine (n=2811).
• Data collection via community pharmacists in the Northern Region.
• Analysis of reported acute dystonic-dyskinetic events and Parkinsonism.

Main Results:

• 12 reports of acute dystonic-dyskinetic events with metoclopramide; incidence higher in patients under 30.
• 8 reports of Parkinsonism with prochlorperazine; 7 in patients over 60.
• Significantly higher incidence of Parkinsonism in patients over 60 compared to those under 60.

Conclusions:

• Metoclopramide is associated with acute dystonic-dyskinetic events, with a notable risk in younger populations.
• Prochlorperazine use carries a risk of Parkinsonism, particularly in elderly patients (over 60).
• Age is a significant factor influencing the risk of specific extrapyramidal side effects for these medications.