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Antiemetics in Parkinson's disease — GPhC CRA MCQ

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ModerateCNS TherapeuticsAntiemetics in Parkinson's diseaseGPhC CRA

A 75-year-old man with Parkinson's disease presents to the pharmacy. He is taking co-beneldopa (Madopar) 125 mg three times daily. He has recently been started on domperidone 10 mg three times daily for nausea. He mentions his GP considered metoclopramide but chose domperidone instead. Why is metoclopramide avoided in Parkinson's disease?

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Correct answer: C — Metoclopramide crosses the blood-brain barrier and can worsen Parkinson's symptoms by blocking dopamine receptors centrally

Metoclopramide is a dopamine antagonist that crosses the blood-brain barrier and can worsen Parkinsonian symptoms by blocking dopamine receptors in the basal ganglia. Domperidone is preferred as an antiemetic in Parkinson's disease because it acts predominantly on peripheral dopamine receptors and has limited central nervous system penetration. However, domperidone should be used at the lowest effective dose due to cardiac risks.

Reference: BNF; NICE NG71 Parkinson's Disease