Metoclopramide-Induced Acute Dystonia: Data From a Pediatric Emergency Unit

Pediatr Emerg Care. 2021 Sep 1;37(9):e528-e533. doi: 10.1097/PEC.0000000000001960.

Abstract

Objectives: Metoclopramide is a commonly used medication in pediatric practice, and dystonia is a common adverse effect of it. The present study aims to evaluate the clinical characteristics of metoclopramide-induced acute dystonic reactions (MIADRs) in pediatric patients admitted to the pediatric emergency unit.

Methods: Twenty-eight patients were admitted with MIADRs between June 2004 and April 2016; they were enrolled into the study retrospectively.

Results: The study group was composed of 13 females and 15 males with the mean ± SD age of the females higher than that of the males, 12.3 ± 4.5 and 7.8 ± 4.3 years, respectively. Only 9 (32.1%) of the patients were diagnosed as MIADRs at the time of admission. Seventeen patients (60.7%) received over the recommended daily dose of metoclopramide. Dystonia was focal in most of the patients, with the most affected parts consisting of the neck, eyes, and orolingual regions. In 9 of the patients, the dystonia was episodic in nature. Pharmacological treatment was used for 18 patients. No patients died, and none suffered long-term injury related to MIADRs.

Conclusions: Metoclopramide administration may be associated with the occurrence of acute dystonic reaction. Metoclopramide-induced acute dystonic reactions may be misdiagnosed, so detailed medical history gathering and a high index of suspicion are warranted. Our data suggest that MIADRs may be dose related and that there may be age- and sex-related differences in the epidemiology of MIADRs.

MeSH terms

  • Adolescent
  • Child
  • Dystonia* / chemically induced
  • Dystonia* / diagnosis
  • Dystonic Disorders*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Metoclopramide / adverse effects
  • Retrospective Studies

Substances

  • Metoclopramide