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.
Copyright © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.