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Anesthesiology/Anti-nausea drugs and PD


Hi - I just read your response to someone asking about the use of anti-nausea drugs and the relationship with PD. I disagree with you completely. Metoclopramide (for eg.) can cause symptoms of PD that continue for a long time after the patient stops taking the drug and can be permanent. It can also actually CAUSE PD. The patient information leaflets provided in the drug packs state this. There are also papers on this (eg. Anderson and Freeman, Practical Gastroenterology, May 2004), plus - not sure if you're aware, but - the FDA has issued a black-box warning about this drug. With respect, I am amazed that anaesthesiologists like yourself aren't aware of how dangerous this drug is. I urge you to please, please, please do some reading on this drug.

Anesthesiologists (including myself) have been and are aware of the black box warning on Metoclopromide (Reglan) but, as with all medicines, there is a risk-benefit analysis that comes into play. If you read the black box warning it states:

"... risk incr. w/ tx duration and total cumulative dose; elderly pts, esp. elderly women, most likely to develop condition ; D/C metoclopramide if s/sx tardive dyskinesia develop; avoid prolonged tx >12wk in all but rare cases where benefit may outweigh risk. "

Reglan is most often used for GERD where the risk of aspiration of gastric contents is greater than Tardive Diskinesia (TD) and it is given as a single dose. I am not aware of any cases of TD after a single dose. While Reglan may be used more commonly in cancer patients, in anesthesia it is not the first line anti-emetic drug. Ondanstetron is our primary drug for nausea and only in resistant cases do we give Reglan, steroids or Droperidol (which also has black box warnings). There are many drugs on the market that have significant "negative" side effects and the physician has to weigh those risks against the potential benefits on a case-by-case basis.

I hope this clears up the confusion.

Ronald Levy, MD
Professor of Anesthesiology


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Ronald Levy, M.D.


Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.

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