Pasricha P Jay, Pehlivanov Nonko, Sugumar Aravind, Jankovic Joseph
Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, USA.
Nat Clin Pract Gastroenterol Hepatol. 2006 Mar;3(3):138-48. doi: 10.1038/ncpgasthep0442.
Metoclopramide, the only drug approved by the FDA for treatment of diabetic gastroparesis, but used off-label for a variety of other gastrointestinal indications, has many potentially troublesome adverse neurologic effects, particularly movement disorders. In this article, we comprehensively review the indications and side effects of metoclopramide, and describe some common pitfalls and strategies to minimize the medicolegal risks to the prescribing physician. Metoclopramide accounts for nearly a third of all drug-induced movement disorders, a common reason for a malpractice suit. The entire spectrum of drug-induced movement disorders, ranging from subtle to life-threatening, can ensue from its use; akathisia and dystonia are generally seen early in the course of metoclopramide-induced movement disorders, whereas tardive dyskinesia and parkinsonism seem to be more prevalent in chronic users. Female sex, age and diabetes are the major risk factors for metoclopramide-induced movement disorders. It is therefore incumbent on gastroenterologists and other prescribing physicians to become familiar with the adverse neurologic effects associated with the use of metoclopramide, and to take appropriate preventive and defensive measures.
甲氧氯普胺是美国食品药品监督管理局（FDA）批准用于治疗糖尿病性胃轻瘫的唯一药物，但也被用于各种其他未标明的胃肠道适应症，它有许多潜在的麻烦的神经不良反应，尤其是运动障碍。在本文中，我们全面回顾了甲氧氯普胺的适应症和副作用，并描述了一些常见的陷阱以及将开处方医生面临的医疗法律风险降至最低的策略。甲氧氯普胺占所有药物引起的运动障碍的近三分之一，这是医疗事故诉讼的常见原因。使用该药可能引发从轻微到危及生命的各种药物引起的运动障碍；静坐不能和肌张力障碍通常在甲氧氯普胺引起的运动障碍过程中早期出现，而迟发性运动障碍和帕金森症在长期使用者中似乎更为普遍。女性、年龄和糖尿病是甲氧氯普胺引起运动障碍的主要风险因素。因此，胃肠病学家和其他开处方医生有责任熟悉与使用甲氧氯普胺相关的神经不良反应，并采取适当的预防和防范措施。
