I'm a little behind in my e-mail (we're buying a new house!), but I see the
question of the side effects of Reglan has come up again.  I posted about this
a while ago, so I'll just resend my original post.
Cynthia D. Payne
LLL of Berkshire County Mass.
**************************************************

I spoke to my husband, a gastroenterologist, about Reglan.  Below is the
information he gave me.  He said he is now reluctant to prescribe it to his
own patients, but granted that most of his caution would be for high dosages
in young people or long term use in the elderly.  He said other drugs were
safer and more effective for GI use, but I reminded him we were interested in
the way Reglan stimulates prolactin release.
He said his main concern was with the high rate of dystonic reactions. (By the
way, for you other non-medical people out there, in my medical dictionary
dystonia is defined as impairment of muscular tone and dyskinesia is defined
as impairment of the power of voluntary movement.  This all means involuntary,
irregular muscle contortions.) How does this affect us?  Interesting
question....
Cynthia D. Payne
LLL of Berkshire County Mass.
***************************
In regard to the cardiac effects my husband cited a paper which came out last
year entitled "Cardiac dysrhythmias associated with the intravenous
administration of ondansetron and metoclopramide."  Anesth Analg  1997
Jun;84(6):1380-1  AUTHOR(S) Baguley WA, Hay WT, Mackie KP, Cheney FW, Cullen
BF

He was also concerned about the nervous system side effects.  From AHFS Drug
Information 1998, the non proprietary drug book put out by the American
Hospital Formulary Service, page 2442 lists cautions for metoclopramide. Under
Nervous System Effects it states:
"True dystonic reactions, which resemble the acute dyskinesias produced by
antipsychotic drugs (e.g. phenothiazines, butyrophenones), reportedly occur in
less than 1% of adults receiving low dosages of metoclopramide (e.g., 30-40 mg
daily) and are not necessarily related to dose. However, dystonic reactions
occur in approximately 25% of young adults (i.e., 18-30 yrs of age) receiving
high dosages of metoclopramide (e.g., 2 mg/kg per dose) during cancer
chemotherapy: in adults older than 30 yrs of age who are receiving similar
dosages of metoclopramide, the incidence of dystonic reactions in only about
1.8%......

Note: According to Hale, to increase prolactin levels Reglan "doses of 15
mg/day were found ineffective, whereas doses of 30-45 mg/day were most
effective".  Also "long-term use of this medication (>2 weeks) is generally
not recommended.

Metoclopramide-induced tardive dyskinesia occurs most commonly in geriatric
patients (particularly geriatric women), usually develops following
discontinuance of the drug, and is manifested by orobuccolingual dyskinetic
movements. The risk of developing tardive dyskinesia and the likelihood that
it will become irreversible are believed to increase with increasing duration
of therapy and total cumulative dose; however, tardive dyskinesia can occur
after relatively brief therapy with the drug at low doses but appears to be
more readily reversible under such circumstances..."

A paper, "Increased Incidence of Levodopa Therapy Following Metoclopramide
Use" in JAMA, Dec 13, 1995, vol 274, No 22 p1780 by Avoron, et al. notes...
"...a threefold elevation in the odds ratio for recent metoclopramide use
among patients who began Levodopa therapy for the treatment of Parkinson's
disease (OR= 3.09:95% confidence interval {CI}, 2.25 to 4.26)."

Sleisenger and Fordtran's Gastrointestinal and Liver Disease 6th ed. (standard
GI text) states on pg. 511 "Thus coupled with its low efficacy, the side
effects of metoclopramide make it a poor choice for use in GERD".  They quote
Miller, L. G. et al Arch. Intern Med. 149:2486, 1989 Metoclopramide induced
movement disorders.  My husband said he hasn't been able to get a copy of this
yet because it's a bit out of date.