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Case Reports
. 2023 Jul 11:14:1201566.
doi: 10.3389/fphar.2023.1201566. eCollection 2023.

Case report: metoclopramide induced acute dystonic reaction in adolescent CYP2D6 poor metabolizers

Franz-Martin Fink  1 , Marta Bognar  1 , Petra Hengl  1 , Markus Paulmichl  2 , Charity Nofziger  3
Affiliations
Case Reports

Case report: metoclopramide induced acute dystonic reaction in adolescent CYP2D6 poor metabolizers

Franz-Martin Fink et al. Front Pharmacol. .

Abstract

Metoclopramide is indicated for the management of gastroesophageal reflux, gastric stasis, nausea, and vomiting. Metoclopramide-induced acute dystonic reactions (MIADRs), along with repetitive involuntary protrusion of the tongue, are well-known phenomena in children and young adults that may appear after the first dose. The drug is primarily metabolized via oxidation by the cytochrome P450 enzyme CYP2D6 and to a lesser extent by CYP3A4 and CYP1A2. A recommendation to decrease metoclopramide dosing in patients with severely limited to no CYP2D6 activity (i.e., poor metabolizers, PMs) is included in the drug label. It is important to note, however, that a requirement or recommendation for pre-emptive testing for CYP2D6 metabolizer status is not included in the drug label. We present two cases of acute dystonia in two non-consanguineous male adolescents: one following metoclopramide and cimetidine administration in a 14-year-old to treat gastroesophageal reflux, and another following metoclopramide and pantoprazole administration in a 17-year-old with acute gastroenteritis. A retrospective pharmacogenetic analysis revealed both patients as CYP2D6 PMs.

Keywords: CYP2D6; acute dystonia; metoclopramide; metoclopramide-induced acute dystonic reactions; pharmacogenetics; pharmacogenomics; poor metabolizer.

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Conflict of interest statement

CN was employed by PharmGenetix GmbH, a private laboratory providing PGx testing, reporting, and interpretation services. The authors declare that this study received funding from the Österreichische Forschungsförderungsgesellschaft GmbH (FFG). The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.

Figures

FIGURE 1
FIGURE 1
Visual example of facial hypotonia (with open mouth most of the time and repeated involuntary protrusion of the tongue) from Case 1.
See this image and copyright information in PMC

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