From the FDA Drug Label
Extrapyramidal Reactions (EPS) Acute dystonic reactions, the most common type of EPS associated with metoclopramide, occur in approximately 0. 2% of patients (1 in 500) treated with 30 to 40 mg of metoclopramide per day. ... Symptoms include involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions) and rarely, stridor and dyspnea, possibly due to laryngospasm;
Extrapyramidal Symptoms (EPS) Acute Dystonic Reactions Acute dystonic reactions occur in approximately 1 in 500 patients treated with the usual adult dosages of 30 to 40 mg/day of metoclopramide ... These symptoms may include involuntary movements of limbs and facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, or dystonic reactions resembling tetanus.
Reglan (metoclopramide) can cause speech deficits, specifically bulbar type of speech, as part of acute dystonic reactions, which are a type of extrapyramidal symptom (EPS) associated with the medication 1 1.
From the Research
Yes, Reglan (metoclopramide) can cause speech deficits as a side effect, particularly as part of its extrapyramidal side effects which include tardive dyskinesia, akathisia, or dystonic reactions. This medication, commonly used to treat gastroesophageal reflux disease (GERD) and to improve stomach emptying, works by blocking dopamine receptors in the brain. These same dopamine-blocking properties that help with gastrointestinal symptoms can affect the extrapyramidal system, which controls motor function including speech production. Speech difficulties may manifest as slurred speech, difficulty articulating words, or changes in speech patterns.
The risk of such side effects, including speech deficits, is highlighted in various studies, with a notable mention in a study from 2 which, although focusing on the risk of tardive dyskinesia, underscores the importance of considering the neurologic side effects of metoclopramide. Another study from 3 reports a case of severe long-lasting adverse effects, including involuntary movements, after short-term, low-dose use of metoclopramide, further emphasizing the potential for significant side effects even at lower doses.
Key Points to Consider:
- The risk of extrapyramidal side effects, including speech deficits, increases with higher doses and longer duration of treatment, especially beyond 12 weeks.
- Elderly patients and those with kidney or liver impairment are at a higher risk.
- If speech changes occur while taking metoclopramide, patients should contact their healthcare provider immediately as these symptoms may indicate a serious adverse reaction.
- The decision to use metoclopramide should be made with caution, considering the potential benefits against the risk of serious side effects, as suggested by studies such as 4 and 5.
Given the potential for serious neurologic side effects, it is crucial for patients taking metoclopramide to be closely monitored for any signs of extrapyramidal symptoms, including speech deficits, and for healthcare providers to consider these risks when prescribing metoclopramide, especially for long-term use or in high-risk populations, as discussed in 6.