Farmaci antiemetici e bilancio tra benefici e rischi: il caso della metoclopramide

Abstract

An 8-year-old girl arrived in the Emergency Department presenting with sudden unilateral right trismus, deviation of the jaw, burning pain in the neck with dystonic deviation of the same backwards and dyskinesia. The mother reported that the child started vomiting and that three days before she had started therapy with metoclopramide 0.5 mg/kg/day IM following her paediatrician’s indication. In the suspicion of metoclopramide-induced extrapyramidal symptoms, blood chemistry tests were performed showing normal results and midazolam 0.2 mg/kg was administered leading to regression of symptoms. After twenty minutes symptoms recurred with pain-induced sinus tachycardia (HR 180 BPM). Therefore, she was administered a second dose of midazolam EV at 0.15 mg/kg that led to a complete and definitive regression of symptoms. Metoclopramide is a neuroleptic drug indicated only for the treatment of post-operative vomiting or chemotherapy in children over one year. The most common adverse reaction is the onset of extrapyramidal symptoms. A careful risk-benefit balance must always be performed before deciding whether to administer an antiemetic drug.