Netherlands - Following an increase in the number of registered cases of extrapyramidal symptoms in children receiving metoclopramide, the Medicines Evaluation Board has restricted the use of metoclopramide in this population to treatment of severe nausea and vomiting of known origin, and only if treatment with other products is ineffective or is not possible.
The MEB considers there are better alternatives to metoclopramide. For example, domperidone is a better choice in treating post-operative nausea in children. Domperidone is also the drug of choice in treating migraine in children because the risk of extrapyramidal effects is lower than with metoclopramide.
Similarly, 5-HT3 receptor antagonists (e.g. ondansetron) are the drugs of choice in nausea due to strongly emetogenic chemotherapy because of better efficacy and fewer adverse events.
Reference: World Health Organization (WHO) Pharmaceutical Newsletter, No 2,2007
In Malaysia, Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) had received the reports of 33 cases of extrapyramidal symptoms in children that caused by metoclopramide. The details of classical symptoms of EPS are as below:
- Oculogyric crisis (22)
- Spasm (2)
- Neck stiffness (4)
- Dystonia (2)
- Torticolitis ( 2)
- Body stiffness ( 1 )
- Jaw stiffness ( 1 )
- Jerky movement (1)
- Muscle stiffness (1)
- Eyes gaze upward/eyes rolling (5)
- Speech disorder (1)
- Back stiffness (1)
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