Risk of extrapyramidal side effects comparing continuous vs. bolus intravenous metoclopramide administration: a systematic review and meta-analysis of randomised controlled trials

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Abstract

Aims and objectives.

To provide evidence about whether intravenous metoclopramide continuous infusion is associated with fewer extrapyramidal side effects than bolus infusion.

Background.

Many studies have described the effects produced by the administration of metoclopramide, as a continuous intravenous infusion or intravenous bolus directly, but there is a lack of consensus about the best administration of this drug to minimise extrapyramidal side effects.

Design.

A meta-analysis was conducted.

Methods.

The search data base was conducted in: Cochrane Library, PubMed, Web of Knowledge and Scopus, to collect randomised controlled trials examining the association between extrapyramidal side effects and intravenous metoclopramide continuous or bolus infusion. Meta-analyses were conducted for the eligible randomised controlled trials by Comprehensive Meta-Analysis. Risk difference and 95% CIs were calculated with the Cochran's Q-statistic, and heterogeneity was assessed with the I2 test.

Results.

Eleven randomised controlled trials were included. Meta-analysis showed that continuous intravenous infusion of metoclopramide produced less extrapyramidal side effects (8%; 95% CI, 5–11%; p < 0·001; I2 = 65%). These improvements were particularly strong in studies scored ≥3 in the Jadad scale (12%; 95% CI, 3–24%; I2 = 0%), in emergency patients (12%; 95% CI, 2–25%; I2 = 0%), in patients who used concomitant drugs (9%; 95% CI, 5–12%; I2 = 80%) and when observation (8%; 95% CI, 5–14%; I2 = 69%) or analogue scale (7%; 95% CI, 1–13%; I2 = 64%) were used to quantify the number of extrapyramidal reactions in patients.

Conclusions.

Compared with bolus administration, continuous intravenous infusion of metoclopramide reduces the appearance of extrapyramidal side effects.

Relevance to clinical practice.

Continuous infusion is an effective intervention to reduce in patients discomfort caused by the extrapyramidal side effects of metoclopramide. Clinicians also reduce the time spent on alleviating these unwanted effects.

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