Should we stop prescribing metoclopramide as a prokinetic drug in critically ill patients?

Abstract

Regulatory agencies in North America and Europe recently re-evaluated the safety of metoclopramide. This re-evaluation resulted in recommendations and restrictions in order to minimise the risk of neurological and other adverse reactions associated with the use of metoclopramide. In the ICU, off-label prescription of metoclopramide is common. We have reviewed the evidence for safety, effectiveness and dosing of metoclopramide in critically ill patients. Furthermore, tachyphylaxis is addressed and alternatives are summarised. Finally, recommendations are presented not to abandon use of metoclopramide in ICU patients, because metoclopramide is considered effective in enhancing gastric emptying and facilitating early enteral nutrition.

• Authors: Y Gert van der Meer, Willem A Venhuizen, Daren K Heyland, Arthur R H van Zanten
• Journal: Critical care (London, England) (Crit Care) Vol. 18 Issue 5 Pg. 502 (Sep 23 2014) ISSN: 1466-609X [Electronic] England
• PMID: 25672546 (Publication Type: Journal Article, Review)

Chemical References

• Metoclopramide

Topics

• Critical Illness (therapy)
• Dose-Response Relationship, Drug
• Drug Prescriptions (standards)
• Humans
• Metoclopramide (adverse effects, pharmacokinetics)
• Nervous System Diseases (chemically induced)
• Pharmacokinetics
• Tachyphylaxis (physiology)