Should we stop prescribing metoclopramide as a prokinetic drug in critically ill patients?

Y Gert Van Der Meer,Arthur R H Van Zanten,Willem A Venhuizen,Daren K Heyland

doi:10.1186/s13054-014-0502-4

Y Gert Van Der Meer, Arthur R H Van Zanten + Show 2 more

Open Access

https://doi.org/10.1186/s13054-014-0502-4

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Abstract

Regulatory agencies in North America and Europe recently re-evaluated the safety of metoclopramide. This re-evaluation resulted in recommendations and restrictions in order to minimise the risk of neurological and other adverse reactions associated with the use of metoclopramide. In the ICU, off-label prescription of metoclopramide is common. We have reviewed the evidence for safety, effectiveness and dosing of metoclopramide in critically ill patients. Furthermore, tachyphylaxis is addressed and alternatives are summarised. Finally, recommendations are presented not to abandon use of metoclopramide in ICU patients, because metoclopramide is considered effective in enhancing gastric emptying and facilitating early enteral nutrition.

Highlights

In past years, regulatory bodies in North America have conducted reviews and issued warnings on metoclopramide
In December 2011 the French medicines regulatory agency L’Agence nationale de sécurité du médicament et des produits de santé requested a review of metoclopramide by the Committee on Medicinal Products for Human Use of the European Medicines Agency (EMA) because of continued safety and efficacy concerns
Metoclopramide remains indicated for prevention of post-operative nausea and vomiting (PONV), radiotherapy-induced nausea and vomiting and delayed chemotherapy-induced nausea and vomiting, and for symptomatic treatment of nausea and vomiting including that associated with acute migraine’ [3]

Summary

Introduction

Regulatory bodies in North America have conducted reviews and issued warnings on metoclopramide. Present use of metoclopramide in critically ill patients Metoclopramide is extensively used as an intravenous prokinetic drug to treat delayed gastric emptying and to facilitate early enteral feeding. The use of erythromycin as a prokinetic drug to improve gastric emptying is off-label.

Results

Conclusion