From the Guidelines
Metoclopramide is not recommended as a first-line treatment for teenagers with irritable bowel syndrome (IBS) due to its limited evidence and potential neurological side effects. The British Society of Gastroenterology guidelines on the management of IBS, published in 2021 1, do not mention metoclopramide as a recommended treatment for IBS. Instead, the guidelines suggest that treatment should commence with dietary therapies or first-line drugs, such as soluble fibre, antispasmodics, or laxatives. For teenagers with IBS, better initial approaches include:
- Dietary modifications, such as following a low-FODMAP diet
- Stress management techniques
- Regular physical activity If medication is needed, options with better safety profiles for teens include:
- Low-dose antispasmodics like hyoscyamine (0.125-0.25mg as needed) for cramping
- Peppermint oil capsules (180-200mg before meals) for pain and bloating
- Polyethylene glycol (17g daily) for constipation-predominant IBS
- Loperamide (2mg as needed, maximum 8mg/day) for diarrhea-predominant cases, as recommended by the guidelines 1. Any medication for teenage IBS patients should be prescribed at the lowest effective dose for the shortest necessary duration, with close monitoring for side effects, as suggested by the guidelines 1. Treatment should be part of a comprehensive approach that addresses dietary triggers, stress factors, and lifestyle modifications under proper medical supervision.
From the Research
Metoclopramide for Teens with IBS
- There is no direct evidence to support the use of metoclopramide for teens with Irritable Bowel Syndrome (IBS) 2.
- However, metoclopramide has been studied in children for other indications, and its safety profile has been evaluated 3.
- The most common adverse effects reported in prospective studies of metoclopramide in children were extrapyramidal symptoms (EPS), diarrhea, and sedation 3.
- Metoclopramide-induced movement disorders, including tardive dyskinesia, have been reported in adults and children 4, 5.
- The risk of extrapyramidal side effects can be reduced by using continuous intravenous infusion instead of bolus infusion 6.
- The overall risk of tardive dyskinesia from metoclopramide use is likely to be less than 1% 5.
Adverse Effects
- Extrapyramidal symptoms (EPS) are a common adverse effect of metoclopramide, reported in 9% of children 3.
- Diarrhea and sedation are also common adverse effects, reported in 6% of children 3.
- Tardive dyskinesia is a rare but potentially serious adverse effect, which may be irreversible 4, 5.
Administration
- Continuous intravenous infusion of metoclopramide may reduce the risk of extrapyramidal side effects compared to bolus infusion 6.
- The choice of administration route and dosage should be individualized based on the patient's specific needs and medical history.