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Acute Dystonic Reaction – Procyclidine — SCE Neurology MCQ

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EasyMovement DisordersAcute Dystonic Reaction – ProcyclidineSCE Neurology

A 30-year-old develops painful torticollis and an oculogyric crisis six hours after receiving metoclopramide. There is no fever, rigidity or autonomic instability. What is the most appropriate immediate management?

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Correct answer: E — Stop metoclopramide and give parenteral anticholinergic treatment such as procyclidine

This is an acute dopamine-blocking drug-induced dystonic reaction. Metoclopramide should be stopped; in adults, an anticholinergic anti-Parkinsonian medicine such as procyclidine is an appropriate symptomatic treatment. The timing and dramatic posturing can mimic neurological disease but do not justify thrombolysis in this clear medication-associated syndrome.

Reference: Metoclopramide and procyclidine Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/13469/smpc