title: [Severe parkinsonism due to metoclopramide: the importance of early recognition].
abstract: In this article, we present 3 women aged 73, 85 and 88 years who developed metoclopramide-induced parkinsonism. Shortly after starting metoclopramide, bradykinesia and rigidity developed in all 3 patients; tremor and postural instability in 2 of them. We discontinued the metoclopramide after 3-6 months; 2 of the patients had fully recovered 4-6 months later. The 3rd patient died from pneumonia, however, 2 months after discontinuation. Metoclopramide, a dopamine D2-antagonist, is a frequently prescribed anti-emetic drug; however, evidence of its efficacy is limited. In many patients, domperidone, another dopamine D2-antagonist, seems to be a better alternative. Movement disorders due to domperidone are uncommon, presumably because it does not cross the blood-brain barrier. It is likely that metoclopramide-induced parkinsonism is not uncommon; however, it is under-recognized. Risk factors are female sex, advanced age, diabetes mellitus and polypharmacy. Follow-up on patients using metoclopramide is advised.
authors.affiliation: Kennemer Gasthuis, afd. Neurologie, Haarlem, the Netherlands. mwjderonde@gmail.com
authors.forename: Maurice W J
authors.initials: MW
authors.lastname: de Ronde
authors.forename: Hylke Jan
authors.initials: HJ
authors.lastname: Kingma
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Munts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects*; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000932:Antiemetics; D008787:Metoclopramide