Prevalence of Chronic Metoclopramide Use and Associated Diagnoses in the US Pediatric Population
Rachel B Weinstein1, Daniel Fife, Sheldon Sloan
1Epidemiology, Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA, rweinst1@its.jnj.com.
Insights
Many US children use metoclopramide chronically, despite its risks. This study estimated the prevalence of chronic metoclopramide use in children and identified gastroesophageal reflux disease (GERD) as a likely indication.
Area of Science:
- Pediatric pharmacology
- Gastroenterology
- Public health
Background:
- Metoclopramide is a key medication for promoting gastrointestinal motility in the US.
- Chronic use in children is concerning due to potential central nervous system complications.
- The medication's approved indications in adults include GERD and diabetic gastroparesis.
Purpose of the Study:
- To estimate the prevalence of chronic metoclopramide use among children in the United States.
- To identify common diagnoses associated with chronic metoclopramide prescriptions in pediatric populations.
- To focus on gastroesophageal reflux disease (GERD) as a probable indication for chronic use in children.
Main Methods:
- Utilized two large health services databases covering privately and publicly insured children.
- Defined chronic metoclopramide use using liberal (≥35 days' supply) and conservative (≥130 days' supply) criteria over a 6-month period.
- Applied derived proportions to US population estimates to determine national prevalence.
Main Results:
- An estimated 89,020 US children used metoclopramide chronically under the liberal definition.
- Approximately 28,222 US children used metoclopramide chronically under the conservative definition.
- Chronic metoclopramide use was substantial in both privately and publicly insured pediatric populations.
Conclusions:
- Significant numbers of US children are treated with metoclopramide for extended periods.
- Symptoms consistent with GERD appear to be a primary driver for this chronic use.
- The findings highlight the need to weigh metoclopramide's risks against benefits in pediatric chronic treatment.
Objective:
Metoclopramide is the only medication widely used to promote gastrointestinal motility in the USA. Despite its appreciable risk of central nervous system complications, it continues to be prescribed to children for chronic use. We sought to estimate the prevalence of chronic metoclopramide use among US children and identify the diagnoses that may have prompted this use. The US metoclopramide label lists only two indications in adults: symptomatic gastroesophageal reflux (GERD) and diabetic gastroparesis. The latter is rare in children so, in examining the indications likely to have prompted chronic metoclopramide use, we focused on GERD.
Methods:
From two health services databases representing privately and publically insured children, respectively, we estimated the number of US children who used metoclopramide chronically and identified the diagnoses recorded at approximately the time when the chronic use began. We defined chronic use liberally as ≥ 35 days' supply, or conservatively as ≥ 130 days' supply in a 6-month period. For each chronic-use definition, insurance type, and age group, we estimated the proportion of children using metoclopramide chronically. We applied these proportions to US population estimates.
Results:
Under the liberal and conservative definitions, respectively, 89,020 and 28,222 US children used metoclopramide chronically.
Conclusion:
In spite of its risk, substantial numbers of US children use metoclopramide chronically for symptoms suggestive of GERD.
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