Respiratory failure following oral administration of metoclopramide.
OBJECTIVE
To report a case of respiratory failure, possibly due to anaphylaxis or asthma exacerbation, following the administration of metoclopramide.


METHODS
A 32-year-old white woman with a history of severe asthma and short-bowel syndrome was admitted for Hickman catheter line sepsis. Two doses of oral metoclopramide 10 mg in solution were administered for nausea and vomiting. Transient dyspnea followed the first dose of metoclopramide, but respiratory failure requiring intubation followed the second dose.


CONCLUSIONS
Respiratory failure has been reported with metoclopramide-induced movement disorders. Three other cases of respiratory failure from anaphylaxis or asthma exacerbation following metoclopramide administration have been reported. Respiratory failure in our patient may be due to anaphylaxis or bronchoconstriction from metoclopramide-induced cholinergic activity of the vagus nerve, possibly through inhibition of acetylcholinesterase.


CONCLUSIONS
The use of metoclopramide in patients with pulmonary dysfunction may warrant caution.
MacLaren
R
R
Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. rxrm@qe2-hsc.ns.ca
Shields
C A
CA
D000284:Administration, Oral; D000328:Adult; D000932:Antiemetics / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects* / Q000627:therapeutic use; D009325:Nausea / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D014839:Vomiting / Q000188:drug therapy
D000932:Antiemetics; D008787:Metoclopramide