Metoclopramide as anti-emetic in paediatrics

Abstract

Editor—In their review of prevention of postoperative vomiting in children, Bolton and colleagues1Bolton CM Myles PS Nolan T Sterne JA Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis.Br J Anaesth. 2006; 97: 593-604Crossref PubMed Scopus (118) Google Scholar conclude that metoclopramide is an efficient drug and anti-emetic drug. However, they neglect to mention its adverse effects that are particularly important in their studied paediatric group. Children, especially females, are at increased risk of acute dystonic reactions such as oculogyric crises. In the UK, there are specific restrictions on the use of metoclopramide in those under 20 yr of age. Stated indications in the British National Formulary for Children2British National Formulary for Children. British Medical Association, Royal Pharmaceutical Society of Great Britain, the Royal College of Paediatrics and Child Health, and the Neonatal and Paediatric Pharmacists Group, London2006Google Scholar are severe intractable vomiting of known cause, vomiting associated with radiotherapy and cytotoxics, as an aid to gastro-intestinal intubation, a prokinetic in neonates and as pre-medication for diagnostic procedures. Therefore, I would urge caution before using such a drug, of moderate efficacy, as prophylaxis of postoperative vomiting in children. Editor—Dr Stanley raises concerns about the incidence of adverse reactions associated with the use of metoclopramide in chidren. He also points out that the British National Formulary warns agains its use in this age group. Although adverse reactions associated with the use of metoclopramide under anaesthesia are likely to be difficult to detect, its incidence has never been established. Intraoperative metoclopramide has been used widely at Melbourne’s Royal Children’s Hospital for the last 15 yr. There have not been any adverse reactions either during or after anaesthesia that have been causally linked to this practice. As such, in view of metoclopramide’s cost and percieved effectiveness, this practice continues. A randomized, controlled trial investigating the efficacy of metoclopramide in chidren has recently been submitted to the British Journal of Anaesthesia for publication. Although we do not suggest that this trial was designed to address the issue of safety, there were no adverse reactions detected. C. M. Bolton * P. S. Myles T. Nolan J. A. Sterne Melbourne, Australia *E-mail: [email protected]