Metoclopramide in Parkinson's disease

Abstract

The effect of metoclopramide given in a dose of 10 mg or 20 mg 3 times a day has been compared with placebo in a double‐blind randomized crossover study in 11 treated parkinsonian patients. Effects on blood pressure, parkinsonian symptoms and signs, and psychopathologic features were measured. There was no significant effect of metoclopramide at either dose level on parkinsonian symptoms and signs as assessed by a neurologist. Patients' self‐scored assessments indicated worsening of tremor at the higher metoclopramide dose (p < 0.025). Psychopathologic features and subjective symptoms were not significantly changed by metoclopramide (nausea was not a problem). Treatment with metoclopramide 30 mg daily was followed by a rise in supine (p < 0.05) and standing (p < 0.02) blood pressure in a subgroup of 5 patients who had postural falls in systolic blood pressure greater than 15 mm Hg when on placebo; no such effect was seen at the higher dose. In the group as a whole there was no drug effect on blood pressure taken supine, erect, or after exercise. Four of the patients expressed treatment preference; 2 were for placebo because of worsened tremor on metoclopramide and 2 for metoclopramide because of improvement in dyskinesia. These findings suggest that despite its dopamine‐blocking action metoclopramide is well tolerated in a dose of 10 mg 3 times a day by parkinsonian patients and might be safely used as an antiemetic without deterioration in function.