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Metoclopramide

Metoclopramide is available under various trade names including Maxolon , Reglan , Degan, Maxeran, Primperan (Sanofi Aventis), Pylomid (Bosnalijek), Cerucal (AWD Pharma), Pramin (Generic), Macperan (in South Korea), and Perinom (in Nepal). It has also been used in combination with paracetamol (acetaminophen) as Paramax and Metomax, or in combination with aspirin as MigraMax. 

“It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, in people with gastroesophageal reflux disease and as a treatment for the gastric stasis often associated with migraine headaches. It has also been used to treat the nausea due to chemotherapy and that occurring post operatively. By inhibiting the action of dopamine, metoclopramide has sometimes been used to stimulate lactation, Metoclopramide is excreted into milk. ”

In terms of how it works, Metoclopramide “appears to bind [sic] to dopamine D2 receptors where it is a receptor antagonist, and is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist. The anti-emetic action of metoclopramide is thought to be due to its antagonist activity at D2 receptors in the central nervous system (CNS). At higher doses, 5-HT3 antagonist activity may also contribute to the anti-emetic effect”. There is also muscarinic activity. A potent combination indeed.

Adverse drug reactions (ADRs) associated with metoclopramide, apart from the hallucinations, include restlessness, drowsiness, dizziness, fatigue, focal dystonia, hypertension, hypotension, hyperprolactinaemia leading to galactorrhea, constipation, depression, headache, and extrapyramidal effects such as oculogyric crisis, agranulocytosis, supraventricular tachycardia, hyperaldosteronism, neuroleptic malignant syndrome, akathisia and tardive dyskinesia.

All of which can contribute to providing the hallucinations.

“Recent research suggests that metoclopramide may be the most common cause of drug-induced movement disorders. The risk of extrapyramidal effects is increased in people under 20 years of age, and with high-dose or prolonged therapy. Effects may be permanent.  In 2009, the USFDA required all manufacturers of metoclopramide to issue a black box warning regarding the risk of tardive dyskinesia with chronic or high-dose use of the drug”.

In those with depression it may worsen the mental state.

In 2012, metoclopramide was one of the top 100 most prescribed medications in the United States.

On Mar, 5, 2015: 19,656 people reported to have side effects when taking Reglan. Among them, 156 people (0.79%) have Hallucination.

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 On Dec, 26, 2016   22,640 people reported to have side effects when taking Reglan.  Among them, 586 people (2.59%) have Death

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