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PD – Metoclopramide Contraindication — SCE Neurology MCQ

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EasyMovement DisordersPD – Metoclopramide ContraindicationSCE Neurology

A 55-year-old man with Parkinson's disease is admitted to hospital for a hip replacement. On the ward, a junior doctor prescribes metoclopramide for post-operative nausea. Within 24 hours, his parkinsonism dramatically worsens with severe rigidity and akinesia. What is the mechanism and what antiemetic should be used instead?

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Correct answer: C — Metoclopramide is a dopamine D2 receptor antagonist that crosses the blood-brain barrier; domperidone is the safer alternative

Explanation lettering: D = shown as A · A = shown as C · E = shown as D · C = shown as E

Metoclopramide is a central dopamine D2 receptor antagonist that crosses the blood-brain barrier, directly antagonising the dopaminergic pathways affected in PD and worsening parkinsonian symptoms. It is contraindicated in PD. Domperidone is a peripheral D2 antagonist that does not significantly cross the blood-brain barrier and is the recommended antiemetic for PD patients. NICE NG71 explicitly advises against the use of dopamine-blocking antiemetics in PD. B: Ondansetron (5-HT3 antagonist) is an alternative but domperidone is preferred. C/D/E: Incorrect mechanisms.

Reference: NICE NG71 Parkinson's Disease (2017); BNF – Metoclopramide Contraindications