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Diabetic autonomic neuropathy — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Diabetic autonomic neuropathyUSMLE Step 3

A patient with diabetic gastroparesis has substantial improvement on metoclopramide. At 10 weeks she asks to continue it indefinitely. Which counseling is most appropriate?

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Correct answer: B — Avoid beyond 12 weeks; if unavoidable, reassess and monitor for tardive dyskinesia

The best answer is “Avoid beyond 12 weeks; if unavoidable, reassess and monitor for tardive dyskinesia”. Metoclopramide can cause potentially irreversible tardive dyskinesia, with risk increasing with duration and cumulative dose. Current FDA labeling advises avoiding a total duration longer than 12 weeks in diabetic gastroparesis; if longer-term use is unavoidable after individualized benefit-risk review, use the shortest duration, periodically reassess need, and routinely monitor for tardive dyskinesia.

Reference: DailyMed FDA Label: Metoclopramide Tablets (revised February 2026): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e15905e0-e0f6-4c8b-ac19-59724d6c4bf0