Does metoclopramide (Metoclopramide) cause involuntary facial movements, also known as dystonic reactions?

From the Guidelines

Yes, metoclopramide can cause involuntary facial movements, which is a side effect known as tardive dyskinesia, as reported in the most recent study 1. This medication, commonly used to treat nausea, vomiting, and certain gastrointestinal disorders, works by blocking dopamine receptors in the brain. The risk of developing these involuntary movements increases with higher doses and longer duration of treatment, particularly when used for more than 12 weeks, as noted in 1. Some key points to consider include:

• Elderly patients, especially older women, and those with diabetes are at higher risk.
• These movements may affect the face, tongue, and jaw, causing grimacing, lip smacking, or tongue protrusion.
• If you experience any unusual facial or body movements while taking metoclopramide, contact your healthcare provider immediately as these symptoms can sometimes become permanent even after stopping the medication.
• For this reason, metoclopramide should be used at the lowest effective dose for the shortest possible duration, typically not exceeding 12 weeks of continuous use, as recommended in 1. Other studies, such as 1 and 1, also support the association between metoclopramide and involuntary facial movements, but 1 is the most recent and highest quality study. In contrast, 1 discusses the use of metoclopramide in the context of antiemesis, but does not provide new information on the risk of involuntary facial movements.

From the FDA Drug Label

Metoclopramide can cause serious side effects, including: Abnormal muscle movements called tardive dyskinesia (TD). These movements happen mostly in the face muscles. Tardive Dyskinesia (see Boxed Warnings) Treatment with metoclopramide can cause tardive dyskinesia (TD), a potentially irreversible and disfiguring disorder characterized by involuntary movements of the face, tongue, or extremities. Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance

Yes, metoclopramide can cause involuntary movement of the face, as it is associated with a risk of developing tardive dyskinesia (TD), which is characterized by involuntary movements of the face, tongue, or extremities 2, 2, 2.

• The risk of developing TD increases with the duration of treatment and the total cumulative dose.
• TD can be potentially irreversible and disfiguring.
• Symptoms of TD may include involuntary movements of the face, tongue, or extremities, such as lip smacking, chewing, or puckering up the mouth, frowning or scowling, sticking out the tongue, blinking and moving the eyes, and shaking of the arms and legs.

From the Research

Metoclopramide and Involuntary Movement of the Face

• Metoclopramide is known to cause extrapyramidal symptoms, including involuntary movements of the face, as reported in several studies 3, 4, 5, 6, 7.
• The most common movement disorders associated with metoclopramide are:
  • Tardive dyskinesia, characterized by involuntary, repetitive movements of the face, tongue, and limbs 4, 5, 7.
  • Dystonic reactions, which can cause involuntary contractions of the muscles in the face and other parts of the body 3, 6.
  • Akathisia, characterized by restlessness and involuntary movements of the face and limbs 6.
• The risk of developing these movement disorders varies, with tardive dyskinesia being the most common, affecting approximately 0.1% of patients per 1000 patient years 5.
• High-risk groups for metoclopramide-induced movement disorders include:
  • Elderly females 4, 5.
  • Diabetics 5.
  • Patients with liver or kidney failure 5.
  • Patients with concomitant antipsychotic drug therapy 5.
• It is essential to monitor patients taking metoclopramide for signs of extrapyramidal symptoms and to adjust the dosage or discontinue the medication if necessary 3, 4, 6, 7.