Effect of metoclopramide infusion rate on akathisia incidence and severity

SUMMARY INTRODUCTION: We aimed to observe the akathisia incidence, magnitude, and onset time in patients who present with nausea/vomiting and/or headache and managed either with slow intravenous (iv) infusion or bolus iv infusion of 10 mg of metoclopramide (MCP). METHODS: We made this randomized, prospective, clinical study in Dokuz Eylul University Hospital Department of Emergency Medicine between July 12, 2001 and december 15, 2001. Consecutively 300 patients were randomized in two groups which 146 of 300 patients were given 10 mg MCP iv with bolus infusion in 2 minutes (BIG) and 154 of 300 patients were given 10 mg MCP iv in 100 ml normal saline with a slow infusion (SIG) in 15 minutes. Akathisia scores were measured in 0, 5th, 15th, 30th, 60th minutes with modified Sachdev akathisia scale. RESULTS: Akathisia were observed in 36 of 146 patients (%24.7) in BIG and in 9 of 154 patients (%5.8) in SIG. Akathisia incidence is significantly smaller in SIG than in BIG (p=0.000). Major akathisia is observed in 1 1 of 36 patients in BIG and incidence of major akathisia is significantly higher than SIG (p=0.009). Percentage of akathisia in first 15 minutes in BIG and SIG were %100 and %77, respectively. Presenting symptoms resolved in 60 minutes in 139 of 154 patients (%90.8) in SIG and in 137 of 146 patients (%94.5) in BIG. There were not any statistical relations between onset of akathisia and age, gender, weight, comorbid diseases, history of allergy, and other characteristics of patients. Side effects other than akathisia did not differ in both groups. Sedation was the most common side effect in both groups. 45CONCLUSION: Akathisia is much less observed in patients who were treated with slow infusion of metoclopramide. There is no significant difference in efficacy of metoclopramide either with bolus infusion or slow infusion in patients with nausea/vomiting and/or headache. We suggest slow infusion of metoclopramide in 1 5 minutes and also close observation of patients in the first 15 minutes for the symptoms of akathisia. 46