Miller L G, Jankovic J
Department of Family Medicine, Baylor College of Medicine, Houston, Tex. 77030.
Arch Intern Med. 1989 Nov;149(11):2486-92. doi: 10.1001/archinte.149.11.2486.
Metoclopramide, a dopamine-2 receptor antagonist used for various gastrointestinal disorders, may cause or exacerbate a variety of extrapyramidal movement disorders. To draw attention to the frequent occurrence of metoclopramide-induced movement disorders, we identified and studied 16 patients who had been exposed to this neuroleptic. The average age at onset was 63 years (range, 24 to 85 years), and women outnumbered men 3 to 1. Tardive dyskinesia was the most common movement disorder (n = 10 [63%]). Five patients had metoclopramide-induced parkinsonism, 1 patient had tardive dystonia, and 1 patient had akathisia. The average duration of exposure prior to onset of movement disorders was 12 months (range, 1 day to 4 years). Therapy was continued for an average of 6 months (range, 1 day to 2 years) after the onset of symptoms, reflecting clinical nonrecognition of the movement disorder and its relationship to metoclopramide. To prevent persistent and disabling movement disorders, long-term use of metoclopramide should be avoided, and patients should be carefully observed for potential neurologic reactions.
甲氧氯普胺是一种用于治疗各种胃肠道疾病的多巴胺 -2 受体拮抗剂，可能会引起或加重多种锥体外系运动障碍。为了引起人们对甲氧氯普胺所致运动障碍频繁发生的关注，我们识别并研究了 16 例接触过这种抗精神病药物的患者。发病的平均年龄为 63 岁（范围为 24 至 85 岁），女性与男性的比例为 3 比 1。迟发性运动障碍是最常见的运动障碍（n = 10 [63%]）。5 例患者出现了甲氧氯普胺所致帕金森综合征，1 例患者出现迟发性肌张力障碍，1 例患者出现静坐不能。运动障碍发作前的平均暴露持续时间为 12 个月（范围为 1 天至 4 年）。症状出现后，治疗平均持续了 6 个月（范围为 1 天至 2 年），这反映出临床对运动障碍及其与甲氧氯普胺的关系认识不足。为防止出现持续性和致残性运动障碍，应避免长期使用甲氧氯普胺，并应仔细观察患者是否有潜在的神经反应。
