Metoclopramide Side Effects

Brand Names: Reglan, Reglan

Please note - some side effects for Metoclopramide may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Metoclopramide - for the consumer

Metoclopramide

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Metoclopramide:

Decreased energy; diarrhea; dizziness; drowsiness; headache; nausea; restlessness; tiredness; trouble sleeping.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); abnormal thinking; confusion; dark urine; decreased coordination; decreased sexual ability; fast, slow, or irregular heartbeat; fever; hallucinations; loss of bladder control; mental or mood changes (eg, depression, anxiety, agitation, jitteriness); seizures; severe or persistent dizziness, headache, or trouble sleeping; severe or persistent restlessness, including inability to sit still; shortness of breath; stiff or rigid muscles; sudden increased sweating; sudden unusual weight gain; suicidal thoughts or actions; swelling of the arms, legs, or feet; uncontrolled muscle movements (eg, of the arms, legs, tongue, jaw, cheeks; twitching; tremors); vision changes; yellowing of the skin or eyes.

Metoclopramide Solution

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Metoclopramide Solution:

Decreased energy; diarrhea; dizziness; drowsiness; headache; nausea; restlessness; tiredness; trouble sleeping.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); abnormal thinking; confusion; dark urine; decreased coordination; decreased sexual ability; fast, slow, or irregular heartbeat; fever; hallucinations; loss of bladder control; mental or mood changes (eg, depression, anxiety, agitation, jitteriness); seizures; severe or persistent dizziness, headache, or trouble sleeping; severe or persistent restlessness, including inability to sit still; shortness of breath; stiff or rigid muscles; sudden increased sweating; sudden unusual weight gain; suicidal thoughts or actions; swelling of the arms, legs, or feet; uncontrolled muscle movements (eg, of the arms, legs, tongue, jaw, cheeks; twitching; tremors); vision changes; yellowing of the skin or eyes.

Metoclopramide Syrup

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Metoclopramide Syrup:

Decreased energy; diarrhea; dizziness; drowsiness; headache; nausea; restlessness; tiredness; trouble sleeping.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); abnormal thinking; confusion; dark urine; decreased coordination; decreased sexual ability; fast, slow, or irregular heartbeat; fever; hallucinations; loss of bladder control; mental or mood changes (eg, depression, anxiety, agitation, jitteriness); seizures; severe or persistent dizziness, headache, or trouble sleeping; severe or persistent restlessness, including inability to sit still; shortness of breath; stiff or rigid muscles; sudden increased sweating; sudden unusual weight gain; suicidal thoughts or actions; swelling of the arms, legs, or feet; uncontrolled muscle movements (eg, of the arms, legs, tongue, jaw, cheeks; twitching; tremors); vision changes; yellowing of the skin or eyes.

For the professional

Metoclopramide

In general, the incidence of adverse reactions correlates with the dose and duration of Metoclopramide administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency.

CNS Effects: Restlessness, drowsiness, fatigue and lassitude may occur. Insomnia, headache, confusion, dizziness or mental depression with suicidal ideation may also occur. In cancer chemotherapy patients being treated with 1 to 2 mg/kg per dose, incidence of drowsiness is about 70%. There are isolated reports of convulsive seizures without clear-cut relationship to Metoclopramide. Rarely, hallucinations have been reported.

Extrapyramidal Reactions (EPS): Acute dystonic reactions, the most common type of EPS associated with Metoclopramide, occur in approximately 0.2% of patients (1 in 500) treated with 30 to 40 mg of Metoclopramide per day. In cancer chemotherapy patients receiving 1 to 2 mg/kg per dose, the incidence is 2% in patients over the ages of 30 to 35, and 25% or higher in pediatric patients and adult patients less than 30 years of age who have not had prophylactic administration of diphenhydramine. Symptoms included involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions) and rarely, stridor and dyspnea possibly due to laryngospasm; ordinarily these symptoms are readily reversed by diphenhydramine.

Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like faces.

Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth, or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance.

Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, foot-tapping. These symptoms may disappear spontaneously or respond to a reduction in dosage.

Neuroleptic Malignant Syndrome: Rare occurrences of neuroleptic malignant syndrome (NMS) have been reported. This potentially fatal syndrome is comprised of the symptom complex of hyperthermia, muscular rigidity, altered consciousness, and autonomic instability.

Endocrine Disturbances: Galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia. Fluid retention secondary to transient elevation of aldosterone.

Cardiovascular: Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure and possible AV block.

Gastrointestinal: Nausea and bowel disturbance, primarily diarrhea.

Hepatic: Rarely, cases of hepatotoxicity, characterized by such findings as jaundice and altered liver function tests, when Metoclopramide was administered with other drugs with known hepatotoxic potential.

Renal: Urinary frequency and incontinence.

Hematologic: A few cases of neutropenia, leukopenia, or agranulocytosis, generally without clear-cut relationship to Metoclopramide. Methemoglobinemia in adults and especially with overdosage in neonates. Sulfhemoglobinemia in adults.

Allergic Reactions: A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.

Miscellaneous: Visual disturbances. Porphyria. Transient flushing of the face and upper body, without alterations in vital signs, following high doses intravenously.

Metoclopramide Injection

In general, the incidence of adverse reactions correlates with the dose and duration of Metoclopramide administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency.

CNS Effects. Restlessness, drowsiness, fatigue and lassitude may occur in patients receiving the recommended prescribed dose of Metoclopramide injection. Insomnia, headache, confusion, dizziness and mental depression with suicidal ideation also may occur. In cancer chemotherapy patients being treated with 1-2 mg/kg per dose, incidence of drowsiness is about 70%. There are isolated reports of convulsive seizures without a clear-cut relationship to Metoclopramide. Rarely, hallucinations have been reported.

Extrapyramidal Reactions (EPS). Acute dystonic reactions, the most common type of EPS associated with Metoclopramide, occur in approximately 0.2% of patients (1 in 500) treated with 30 to 40 mg of Metoclopramide per day. In cancer chemotherapy patients receiving 1-2 mg/kg per dose, the incidence is 2% in patients over the ages of 30-35, and 25% or higher in pediatric patients and adult patients less than 30 years of age who have not had prophylactic administration of diphenhydramine. Symptoms include involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions) and rarely, stridor and dyspnea, possibly due to laryngospasm; ordinarily these symptoms are readily reversed by diphenhydramine.

Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies.

Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance.

Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, and foot tapping. These symptoms may disappear spontaneously or respond to a reduction in dosage.

Neuroleptic Malignant Syndrome. Rare occurrences of neuroleptic malignant syndrome (NMS) have been reported. This potentially fatal syndrome is comprised of the symptom complex of hyperthermia, muscular rigidity, altered consciousness, and autonomic instability.

Endocrine Disturbances. Galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia. Fluid retention secondary to transient elevation of aldosterone.

Cardiovascular. Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure, and possible atrioventricular (AV) block.

Gastrointestinal. Nausea and bowel disturbances, primarily diarrhea.

Hepatic. Rarely, cases of hepatotoxicity, characterized by such findings as jaundice and altered liver function tests, when Metoclopramide was administered with other drugs with known hepatotoxic potential.

Renal. Urinary frequency and incontinence.

Hematologic. A few cases of neutropenia, leukopenia, or agranulocytosis, generally without a clear-cut relationship to Metoclopramide. Methemoglobinemia, in adults and especially with overdosage in neonates. Sulfhemoglobinemia in adults.

Allergic Reactions. A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.

Miscellaneous. Visual disturbances, Porphyria.

Transient flushing of the face and upper body, without alterations in vital signs, following high doses intravenously.

Metoclopramide Injection USP

In general, the incidence of adverse reactions correlates with the dose and duration of Metoclopramide administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency.

CNS Effects: Restlessness, drowsiness, fatigue and lassitude may occur in patients receiving the recommended prescribed dose of Metoclopramide injection. Insomnia, headache, confusion, dizziness or mental depression with suicidal ideation also may occur. In cancer chemotherapy patients being treated with 1-2 mg/kg per dose incidence of drowsiness is about 70%. There are isolated reports of convulsive seizures without a clear-cut relationship to Metoclopramide. Rarely, hallucinations have been reported.

Extrapyramidal Reactions (EPS): Acute dystonic reactions, the most common type of EPS associated with Metoclopramide, occur in approximately 0.2% of patients (1 in 500) treated with 30 mg to 40 mg of Metoclopramide per day. In cancer chemotherapy patients receiving 1-2 mg/kg per dose, the incidence is 2% in patients over the ages of 30-35, and 25% or higher in pediatric patients and adult patients less than 30 years of age who have not had prophylactic administration of diphenhydramine. Symptoms include involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions) and rarely, stridor and dyspnea possibly due to laryngospasm; ordinarily these symptoms are readily reversed by diphenhydramine.

Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies.

Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance.

Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, foot-tapping. These symptoms may disappear spontaneously or respond to a reduction in dosage.

Neuroleptic Malignant Syndrome: Rare occurrences of neuroleptic malignant syndrome (NMS) have been reported. This potentially fatal syndrome is comprised of the symptom complex of hyperthermia, muscular rigidity, altered consciousness, and autonomic instability.

Endocrine Disturbances: Galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia. Fluid retention secondary to transient elevation of aldosterone.

Cardiovascular: Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure, and possible atrioventricular (AV) block.

Gastrointestinal: Nausea and bowel disturbances, primarily diarrhea.

Hepatic: Rarely, cases of hepatotoxicity, characterized by such findings as jaundice and altered liver function tests, when Metoclopramide was administered with other drugs with known hepatotoxic potential.

Renal: Urinary frequency and incontinence.

Hematologic: A few cases of neutropenia, leukopenia, or agranulocytosis, generally without a clear-cut relationship to Metoclopramide. Methemoglobinemia in adults and especially with overdosage in neonates. Sulfhemoglobinemia in adults.

Allergic Reactions: A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.

Miscellaneous: Visual disturbances. Porphyria. Transient flushing of the face and upper body, without alterations in vital signs, following high doses intravenously.

Metoclopramide Injection USP

In general, the incidence of adverse reactions correlates with the dose and duration of Metoclopramide administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency.

CNS Effects: Restlessness, drowsiness, fatigue and lassitude may occur in patients receiving the recommended prescribed dose of Metoclopramide injection. Insomnia, headache, confusion, dizziness or mental depression with suicidal ideation also may occur. In cancer chemotherapy patients being treated with 1-2 mg/kg per dose incidence of drowsiness is about 70%. There are isolated reports of convulsive seizures without a clear-cut relationship to Metoclopramide. Rarely, hallucinations have been reported.

Extrapyramidal Reactions (EPS): Acute dystonic reactions, the most common type of EPS associated with Metoclopramide, occur in approximately 0.2% of patients (1 in 500) treated with 30 mg to 40 mg of Metoclopramide per day. In cancer chemotherapy patients receiving 1-2 mg/kg per dose, the incidence is 2% in patients over the ages of 30-35, and 25% or higher in pediatric patients and adult patients less than 30 years of age who have not had prophylactic administration of diphenhydramine. Symptoms include involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions) and rarely, stridor and dyspnea possibly due to laryngospasm; ordinarily these symptoms are readily reversed by diphenhydramine.

Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies.

Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance.

Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, foot-tapping. These symptoms may disappear spontaneously or respond to a reduction in dosage.

Neuroleptic Malignant Syndrome: Rare occurrences of neuroleptic malignant syndrome (NMS) have been reported. This potentially fatal syndrome is comprised of the symptom complex of hyperthermia, muscular rigidity, altered consciousness, and autonomic instability.

Endocrine Disturbances: Galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia. Fluid retention secondary to transient elevation of aldosterone.

Cardiovascular: Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure, and possible atrioventricular (AV) block.

Gastrointestinal: Nausea and bowel disturbances, primarily diarrhea.

Hepatic: Rarely, cases of hepatotoxicity, characterized by such findings as jaundice and altered liver function tests, when Metoclopramide was administered with other drugs with known hepatotoxic potential.

Renal: Urinary frequency and incontinence.

Hematologic: A few cases of neutropenia, leukopenia, or agranulocytosis, generally without a clear-cut relationship to Metoclopramide. Methemoglobinemia in adults and especially with overdosage in neonates. Sulfhemoglobinemia in adults.

Allergic Reactions: A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.

Miscellaneous: Visual disturbances. Porphyria. Transient flushing of the face and upper body, without alterations in vital signs, following high doses intravenously.

Metoclopramide Tablets

In general, the incidence of adverse reactions, correlates with the dose and duration of Metoclopramide administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency:

CNS Effects: Restlessness, drowsiness, fatigue and lassitude occur in approximately 10% of patients receiving the most commonly prescribed dosage of 10 mg q.i.d.. Insomnia, headache, confusion, dizziness or mental depression with suicidal ideation occur less frequently. The incidence of drowsiness is greater at higher doses. There are isolated reports of convulsive seizures without clearcut relationship to Metoclopramide. Rarely, hallucinations have been reported.

Extrapyramidal Reactions (EPS): Acute dystonic reactions, the most common type of EPS associated with Metoclopramide, occur in approximately 0.2% of patients (1 in 500) treated with 30 to 40 mg of Metoclopramide per day. Symptoms include involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions) and rarely, stridor and dyspnea, possibly due to laryngospasm; ordinarily these symptoms are readily reversed by diphenhydramine.

Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies.

Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance.

Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, foot tapping. These symptoms may disappear spontaneously or respond to a reduction in dosage.

Neuroleptic Malignant Syndrome: Rare occurrences of neuroleptic malignant syndrome (NMS) have been reported. This potentially fatal syndrome is comprised of the symptom complex of hyperthermia, altered consciousness, muscular rigidity, and autonomic dysfunction.

Endocrine Disturbances: Galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia. Fluid retention secondary to transient elevation of aldosterone.

Cardiovascular: Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure and possible AV block.

Gastrointestinal: Nausea and bowel disturbances, primarily diarrhea.

Hepatic: Rarely, cases of hepatotoxicity characterized by such findings as jaundice and altered liver function tests, when Metoclopramide was administered with other drugs with known hepatotoxic potential.

Renal: Urinary frequency and incontinence.

Hematologic: A few cases of neutropenia, leukopenia, or agranulocytosis, generally without clearcut relationship to Metoclopramide. Methemoglobinemia, in adults and especially with overdosage in neonates.

Sulfhemoglobinemia in adults.

Allergic Reactions: A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.

Miscellaneous: Visual disturbances. Porphyria.

By body system

Nervous system side effects

Tardive dyskinesia involves involuntary, dyskinetic, repetitive movements and may be more common in elderly women. Tardive dyskinesia may be irreversible and is related to both the duration of therapy and the total amount of drug consumed. Frequent discontinuation and resumption of therapy may predispose patients to the development of tardive dyskinesia.

Dystonias frequently involve tongue protrusions, muscle rigidity, torticollis, and opisthotonos. Dystonias usually resolve after metoclopramide discontinuation, but may require antihistamine and antiparkinsonian therapy if symptoms are severe or if respiration is compromised. Treatment of dystonic reactions and extrapyramidal effects, in addition to general supportive measures, may include judicious use of one or more of the following: benztropine or diphenhydramine.

Hyperthermia, altered consciousness, autonomic dysfunction, and muscle rigidity are the hallmarks of the neuroleptic malignant syndrome. The neuroleptic malignant syndrome is associated with a case fatality rate of about 20%. Immediate discontinuation of metoclopramide therapy, consideration of dantrolene administration, as well as intensive monitoring and supportive care are indicated.

Drug-induced parkinsonian symptoms due to metoclopramide may be misdiagnosed and inappropriately treated with dopaminergic agents. Parkinsonian-like symptoms have occurred, more commonly within the first 6 months from the start of therapy with metoclopramide, but occasionally after longer periods. Caution should be exercised when diagnosing movement disorders in patients currently being treated with metoclopramide. Additionally, metoclopramide should be avoided in patients with confirmed Parkinson's disease.

Patients with AIDS or HIV-positive may be at an increased risk of developing acute dystonia to metoclopramide use. Decreases in dopamine levels have been observed in a study of AIDS patients without clinical neurologic disease. Similarly, HIV-positive patients have shown a decreased response in serum prolactin during intravenous infusion of metoclopramide when compared with controls, interpreted as an indirect evidence of a diminished endogenous dopamine tone.

Nervous system side effects have been commonly reported and included drowsiness, fatigue, restlessness, and lassitude in approximately 10% of patients. Drowsiness may occur in up to 70% of cancer patients treated with high-dose (1 to 2 mg/kg/dose) metoclopramide. Tardive dyskinesia, dystonia, pseudo-parkinsonism, and the neuroleptic malignant syndrome have also been reported. In addition, cases of akathisia have been reported. Seizures and hallucinations have been reported rarely. At least one case of lightheadedness has also been reported.

Endocrine side effects

Endocrine side effects have included galactorrhea, amenorrhea, gynecomastia, and impotence secondary to hyperprolactinemia. In addition, metoclopramide may cause a transient increase in circulating aldosterone levels and subsequently cause edema.

Psychiatric side effects

Depression may occur in patients without prior history of depression or other psychiatric illness and may be severe. Suicidal ideation may be present. Several reports suggest that dose reduction may alleviate depressive symptomatology. In addition, reintroduction of metoclopramide with slow titration of the dose upwards to a therapeutic level has been successful in some patients.

Psychiatric side effects have included depression, anxiety, mania, psychosis, and insomnia.

Cardiovascular side effects

It is postulated that metoclopramide may indirectly cause release of catecholamines from tumors in pheochromocytoma patients. Hypertensive crisis may ensue. The use of metoclopramide is considered contraindicated in patients with pheochromocytoma.

Hypertensive crisis has been documented in the absence of pheochromocytoma as well. The manufacturer recommends cautious use of metoclopramide in patients with essential hypertension.

Sinus bradycardia (50 beats per minute) progressing to complete heart block with sinus arrest has been reported in a 54-year-old man after receiving metoclopramide 10 mg IV. Asystole lasted approximately 25 seconds, followed by a spontaneous increase in heart rate to 80 beats per minute in sinus rhythm with a blood pressure of 140/70 mm Hg. Similar effects were observed on rechallenge with a dose of metoclopramide 5 mg given slowly. No changes in ST segment or QRS complexes were observed on electrocardiogram.

Cardiovascular side effects have included hypertension, hypotension, supraventricular tachycardia, bradycardia, and cardiac arrest. In addition, metoclopramide is associated with hypertensive crisis in patients with pheochromocytoma and has been implicated in a case of congestive heart failure.

Hematologic side effects

Patients with NADH-cytochrome b5 reductase deficiency who need to receive metoclopramide are at increased risk of developing methemoglobinemia and/or sulfhemoglobinemia. The treatment of metoclopramide-induced methemoglobinemia with methylene blue is not recommended in patients with G6PD deficiency.

Hematologic side effects including leukopenia, neutropenia, porphyria, and agranulocytosis have been reported rarely. Methemoglobinemia has also been reported with metoclopramide use in adults, but may be more common in infants who are treated with high doses.

Hepatic side effects

Hepatic side effects have included rare reports of elevations in liver function tests and jaundice. A case of arteriovenous shunting and cholestasis in conjunction with hepatic hemangiomatosis has been reported.

A 22-year-old female, treated with metoclopramide 10 to 15 mg per day for 7 to 8 months for abdominal pain, developed hepatic hemangiomatosis with arteriovenous shunting and cholestasis. Hyperprolactinemia, galactorrhea, amenorrhea, and virilization were also noted on initial presentation. The patient was placed on a waiting list for liver transplantation. However, complete, albeit slow, resolution occurred following discontinuation of metoclopramide.

Genitourinary side effects

Genitourinary side effects have included urinary frequency, incontinence, and urinary retention.

Hypersensitivity side effects

Hypersensitivity side effects have included rash, urticaria, bronchospasm, angioneurotic edema, and glossal or laryngoedemal reactions.

Gastrointestinal side effects

Gastrointestinal side effects have included nausea and diarrhea.

Respiratory side effects

Respiratory side effects have been reported rarely. A case of metoclopramide-induced bronchospasm is reported in the literature.

Other side effects

Other side effects have included porphyria, local pain during intravenous injection, and transient flushing during high-dose infusion. At least one case of generalized weakness has been reported.

Renal side effects

Renal side effects have included urinary frequency and incontinence.

Ocular side effects

Ocular side effects have included visual disturbances. Decrease in pupil diameter and transiently depressed reflex dilation have been reported in patients undergoing lower abdominal surgery under combined epidural/general anesthesia.

Musculoskeletal side effects

A 28-year-old female experienced dystonic reaction coincident with metoclopramide therapy. She had started taking metoclopramide the day before her presentation to the hospital. Her symptoms resolved six to eight hours after onset.

Musculoskeletal side effects have included a case of dystonic reaction.

General side effects

In general, the incidence of side effects correlates with dose and duration of metoclopramide therapy. The elderly may be more susceptible to developing adverse effects due to the changes in organ function, concomitant diseases, and other drug therapies.

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