From the Research
Reglan (metoclopramide) should be used with caution in patients with bipolar disorder due to its potential to worsen psychiatric symptoms. This medication, primarily used for gastrointestinal disorders like GERD or gastroparesis, works by blocking dopamine receptors and can potentially trigger or exacerbate manic episodes, depression, or psychotic symptoms in bipolar patients. The most recent and highest quality study, 1, highlights the importance of careful management of bipolar disorder, including the potential risks of medication interactions and the need for close monitoring of patients.
Key Considerations
- If Reglan must be used in someone with bipolar disorder, it should be prescribed at the lowest effective dose (typically starting at 5mg three times daily before meals) for the shortest duration possible (ideally less than 12 weeks to also minimize risk of tardive dyskinesia) 1.
- Close monitoring for mood changes, agitation, or worsening psychiatric symptoms is essential, as emphasized in 2 and 3.
- Patients should continue their bipolar medications as prescribed during Reglan treatment, and alternative medications for gastrointestinal symptoms that don't affect dopamine receptors, such as proton pump inhibitors for GERD or erythromycin for gastroparesis, may be safer options for bipolar patients.
- The risk occurs because bipolar disorder involves dysregulation of neurotransmitters including dopamine, and Reglan's dopamine-blocking effects can disrupt this already sensitive balance, as discussed in 4 and 5.
Management and Monitoring
- A thorough diagnostic evaluation and supportive case-finding tools are essential to reach an accurate diagnosis of bipolar disorder, as noted in 5.
- Pharmacologic treatment underpins both short- and long-term management of bipolar disorder, with maintenance treatment to prevent relapse frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms, as discussed in 1 and 2.
- Monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health, as emphasized in 1 and 3.