After discussing the article “Acute dystonic reaction caused by metoclopramide, versus tetanus” published by BMJ1 our staff have decided to make some brief comments on the topic.
Metoclopramide is a gastrokinetic medication with antiemetic properties. It was initialy prescribed for nauseas due to pregnancy but at present it is also used in the chemotherapy induced nausea and vomiting, in diabetic gastroparesia and in all those disorders characterized by decreased digestive transit.
In general terms, metoclopramide is well tolerated and its secondary effects, observed only in 10% of the cases, are usually fatigue, somnolence and sedation. Extrapyramidal effects include atacsia, facial distonias, torticolis, ocular turning crisis and trismus. 2, 3
In our department, 14 652 patients, received dental care during the year 2006. Out of them, only five cases presented with trismus due to metoclopramide intake, which had been prescribed for vomiting. Treatment had been extended for three weeks in two cases. One of these patients reported temporomandibular articulation dysfuntion of the masticatory muscular level which resulted in a protective contraction (muscle fixation). Reduction of the bucal opening and muscle pain on palpation were easily recognized in the clinical picture.
Most cases evolved satisfactorily and hospital admission was not required due to inmediate drug administration and continiuous ambulatory follow up care given by our department staff.
References:
1.Dingli K, Morgan R, Leen C. Acute dystonic reaction caused by metoclopramide, versus tetanus. BMJ 2007; 334: 899-900.
2.Camaño et al. Prevención y tratamiento de los síndromes extrapiramidales. Rev Med Uruguay 1987; 3: 63-70.
Rapid Response:
Trismus caused by metoclopramide
After discussing the article “Acute dystonic reaction caused by metoclopramide, versus tetanus” published by BMJ1 our staff have decided to make some brief comments on the topic.
Metoclopramide is a gastrokinetic medication with antiemetic properties. It was initialy prescribed for nauseas due to pregnancy but at present it is also used in the chemotherapy induced nausea and vomiting, in diabetic gastroparesia and in all those disorders characterized by decreased digestive transit.
In general terms, metoclopramide is well tolerated and its secondary effects, observed only in 10% of the cases, are usually fatigue, somnolence and sedation. Extrapyramidal effects include atacsia, facial distonias, torticolis, ocular turning crisis and trismus. 2, 3
In our department, 14 652 patients, received dental care during the year 2006. Out of them, only five cases presented with trismus due to metoclopramide intake, which had been prescribed for vomiting. Treatment had been extended for three weeks in two cases. One of these patients reported temporomandibular articulation dysfuntion of the masticatory muscular level which resulted in a protective contraction (muscle fixation). Reduction of the bucal opening and muscle pain on palpation were easily recognized in the clinical picture.
Most cases evolved satisfactorily and hospital admission was not required due to inmediate drug administration and continiuous ambulatory follow up care given by our department staff.
References:
1.Dingli K, Morgan R, Leen C. Acute dystonic reaction caused by metoclopramide, versus tetanus. BMJ 2007; 334: 899-900.
2.Camaño et al. Prevención y tratamiento de los síndromes extrapiramidales. Rev Med Uruguay 1987; 3: 63-70.
3.Bateman DN, Rawlins MD, Simpson JM: Extrapyramidal reactions with metoclopramide. BMJ 1985; 291: 930-2.
Competing interests:
None declared
Competing interests: No competing interests