Safety of metoclopramide in traumatic brain injury patients: A systematic review of literature

Abstract

Background: One in every three related-injury deaths in United State are linked directly to traumatic brain injury (TBI), for which it is considered as a leading cause of death. Traumatic brain injury took place due to severe head assault to a hard object, with headache and vomiting being amongst the most common presenting symptoms. Metoclopramide is an old antiemetic agent that has been used widely for nausea and vomiting in TBI patients.

Aim: A systematic review of the literature to investigate the safety of metoclopramide in treating traumatic brain injury patients.

Methods: A literature review was conducted in 6 databases, we determine the pertinence of a study to the inclusion criteria by assessing the title, keywords, and abstracts. Five studies were found to be relevant. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed.

Results: The collective sample size was 93 patients with an average of age 38.5 years. 51.6 % were male and 48.6% were females. Most patients received 10 mg metoclopramide IV with a percentage of 77.4%. While only 22.5% received 20 mg IV metoclopramide. Seventy-one patients received metoclopramide alone and 22 received combination therapy.  Headache was the most common reported side effect (46.2 %), followed by anxiety and drowsiness with (39.7%) and (27.9 %); respectively. Fatigue reported in (24.7%), while dystonia was the least common and developed only in 5.3%.

Conclusion: Metoclopramide is a common medication used to treat TBI patients in the emergency department. However, the review demonstrated that the central nervous system (CNS) side effect is excepted. Alternative options with lower CNS side effects may be better tried.