Metoclopramide Dystonia — SCE Medical Oncology MCQ

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EasyOncological EmergenciesMetoclopramide DystoniaSCE Medical Oncology

A 72-year-old woman with chemotherapy-induced nausea is prescribed metoclopramide. She develops acute dystonic reaction (torticollis, oculogyric crisis) 2 hours after the first dose. What is the immediate treatment?

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Correct answer: E — Procyclidine 5 mg IV (or IM)

Metoclopramide-induced acute dystonia is caused by dopamine D2 receptor blockade in the basal ganglia. It is more common in young patients and with high doses. The immediate treatment is an anticholinergic agent: procyclidine 5 mg IV (or IM) or benzatropine. Response is usually rapid (minutes). Metoclopramide should be avoided in future. MHRA has restricted metoclopramide use to maximum 5 days in adults due to extrapyramidal side effects. Alternative prokinetic antiemetics (domperidone) have lower CNS penetration and dystonia risk.

Reference: BNF Metoclopramide; MHRA Drug Safety Update Metoclopramide 2013; ESMO Antiemetic Guidelines