Metoclopramide and homicidal ideation: a case report and literature review

Psychosomatics. Sep-Oct 2011;52(5):403-9. doi: 10.1016/j.psym.2011.02.001.

Abstract

Background: Metoclopramide is an anti-emetic and gastrointestinal pro-motility agent associated with well-known neuropsychiatric adverse effects, such as dyskinesia, akathisia, and depression. It has never been reported to be associated with homicidal ideation.

Objective: The authors review the literature on metoclopramide-induced adverse neuropsychiatric reactions and the mechanisms by which these may occur.

Methods: The authors present a case report of a patient who developed anxiety, agitation, suicidal and homicidal ideation following brief exposure to metoclopramide.

Results: The adverse effects of agitation and homicidal ideation were temporally related to the starting and stopping of metoclopramide. The patient subsequently developed agitation without homicidal ideation when given a serotonergic antidepressant a week later, suggesting that serotonin handling may have played a significant role in causing the patient's symptoms.

Conclusions: Although metoclopramide is well-known for its side effects related to dopamine blockade, its action at 5-HT₃ and 5-HT₄ receptors may also be clinically significant in the genesis of neuropsychiatric side effects, especially related to mood and behavior.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Affect / drug effects
  • Akathisia, Drug-Induced / etiology
  • Akathisia, Drug-Induced / psychology
  • Antiemetics / adverse effects*
  • Antiemetics / therapeutic use
  • Dopamine D2 Receptor Antagonists
  • Fantasy*
  • Homicide / psychology*
  • Humans
  • Male
  • Metoclopramide / adverse effects*
  • Metoclopramide / therapeutic use
  • Nausea / drug therapy
  • Serotonin Antagonists / adverse effects

Substances

  • Antiemetics
  • Dopamine D2 Receptor Antagonists
  • Serotonin Antagonists
  • Metoclopramide