Levosulpiride Use in Chronic Kidney Disease Patients – Do We Need to Be Cautious?

Abstract

Background: A challenging scenario for today’s clinician is to treat dyspeptic symptoms among the chronic kidney disease (CKD) patients. Levosulpiride is a substituted benzamide which is most commonly used as a prokinetic drug. At present there is enough evidence to say that levosulpiride causes movement disorders (LIM) when used in elderly patients. This study attracts attention as there was high occurrence of extra pyramidal symptoms (EPS) in CKD patients even with recommended doses for dyspeptic symptoms. Methodology: This study was done in the Department Of Nephrology of a tertiary care private hospital by retrospective analysis of data gathered from patients who had developed movement disorders following exposure to levosulpiride for dyspeptic symptoms. Statistical analysis was done using Microsoft XL sheet. Results: Twelve patients (nine males and three females) with varying degrees of chronic kidney disease who developed levosulpiride induced movement disorders were included in the study. The number of patients who developed dystonia, Parkinsonism, isolated tremors and Orofacial dyskinesia were eight, two, one, and one (66.6%, 16.6%, 8.3% and 8.3%) respectively. All except one patient recovered completely after the discontinuation of medication. Conclusion: Levosulpiride is an effective prokinetic agent. Even though the occurrence of LIM is rare in patients with normal kidney function, LIM occurs much more commonly in chronic kidney disease patients contrary to the belief. Hence the dose of levosulpiride should be modified in patients with chronic kidney disease and prompt discontinuation of levosulpiride should be done with the occurrence of LIM as it leads to complete recovery of symptoms.