Tardive dyskinesia associated with metoclopramide

Area of Science:

• Pharmacovigilance
• Neurology
• Geriatrics

Background:

• Tardive dyskinesia (TD) is a serious neurological side effect associated with dopamine receptor-blocking agents.
• Metoclopramide, a commonly prescribed gastrointestinal stimulant, has been implicated in TD cases.
• Previous reports suggested a potential risk, necessitating further investigation into incidence and risk factors.

Purpose of the Study:

• To estimate the incidence of tardive dyskinesia (TD) associated with metoclopramide treatment.
• To identify patient demographics and treatment characteristics associated with TD development.
• To assess the risk of TD in elderly patients receiving long-term metoclopramide therapy.

Main Methods:

• Analysis of case reports submitted to the Swedish Adverse Drug Reactions Advisory Committee (1977-1981).
• Calculation of incidence rates using total drug sales and prescription data.
• Extrapolation of data from a survey of individual prescriptions for long-term treatment in elderly patients (≥70 years).

Main Results:

• Eleven cases of metoclopramide-associated tardive dyskinesia were reported, predominantly in women (mean age 76 years).
• Median treatment duration before symptom onset was 14 months.
• Estimated incidence of TD was 1 in 2000-2800 treatment years, exceeding 1 in 1000 patients for those ≥70 years on long-term treatment.

Conclusions:

• Long-term metoclopramide treatment carries a substantial risk of tardive dyskinesia.
• Elderly individuals, particularly women, are at increased risk.
• Caution is advised for prolonged metoclopramide use, especially in geriatric populations.