Dystonic reactions with metoclopramide: is there a risk population?

The authors examine 18 cases of early dystonic syndromes and review all the pediatric cases published previously in order to determine the evolutive and epidemiological characters of these intolerance reactions. These unrecognized manifestations normally occur within the first 24 hours of treatment and disappear within a few hours when the treatment is discontinued. The use of diazepam and trihexyphenidyl accelerates the regression of the disorders. The doses of metoclopramide were mostly above the recommended doses, 60% of the cases correspond to doses in excess of 0.5 mg/kg per day or 0.2 mg/kg in a single dose. In the absence of overdosage, dystonic reactions occur essentially in female subjects aged over 9 years. For this part of the population, the possible occurrence of such a reaction should be mentioned to the family when the drug is prescribed.