From the Guidelines
The reaction to Reglan (metoclopramide) that makes a patient want to run out of the department is called akathisia, an extrapyramidal side effect characterized by an intense feeling of inner restlessness, agitation, and an irresistible urge to move, as described in the most recent study 1. This condition is often misinterpreted as psychotic agitation or anxiety and is a common reason for medication noncompliance, as noted in earlier studies 1. Key characteristics of akathisia include:
- An intense feeling of inner restlessness
- Agitation
- An irresistible urge to move
- Inability to sit still
- Constant pacing
- Shifting weight from one foot to another
- Extreme discomfort Akathisia typically occurs within hours of metoclopramide administration and is dose-dependent, as reported in the study 1. If a patient develops akathisia, treatment involves discontinuing metoclopramide and administering diphenhydramine (Benadryl) 25-50 mg IV or benzodiazepines like lorazepam 1-2 mg IV for symptom relief, as suggested in the guidelines 1. The reaction occurs because metoclopramide blocks dopamine receptors in the brain, disrupting the balance between dopamine and acetylcholine in the nigrostriatal pathway, which is a well-established mechanism 1. Patients should be monitored for this reaction when receiving metoclopramide, especially those receiving higher doses or with risk factors such as young age, female gender, or rapid IV administration, as recommended in the most recent study 1.
From the FDA Drug Label
Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, and foot tapping. The reaction to Reglan that makes the patient want to run out of the department is called akathisia, which is characterized by feelings of anxiety, agitation, and restlessness, and may include symptoms such as inability to sit still, pacing, and foot tapping 2.
From the Research
Reaction to Reglan
The reaction to Reglan (metoclopramide) that makes a patient want to run out of the department is called akathisia.
- Akathisia is characterized by an inner restlessness resulting in a need for constant movement 3.
- It is associated with significant distress on behalf of the patients and limits treatment adherence 4.
- Akathisia can be acute or tardive, with acute akathisia commonly resolving upon treatment discontinuation, but tardive and chronic akathisia may persist after the causative agent is withdrawn 4.
Symptoms of Akathisia
The symptoms of akathisia include:
- Severe restlessness commonly accompanied by dysphoria and purposeless movement which relieves subjective tension 4.
- A sensation of restlessness and distress, as well as constant, non-purposeful limb movement 5.
- Subjective restlessness, which can be reported by patients 6.
Management of Akathisia
The management of akathisia includes:
- Discontinuation of the causative drug 4.
- Use of propranolol and low-dose mirtazapine, which are the most thoroughly studied pharmacological interventions for akathisia 4.
- Benzodiazepines, voltage-gated calcium channel blockers (gabapentin, pregabalin), and opioids may be effective in treating akathisia 4.
- Midazolam can correct the symptoms of metoclopramide-induced akathisia faster than diphenhydramine, but it causes more sedation 7.