Risk and Severity of Akathisia Following Administration of Metoclopramide in the Emergency Department

ABSTRACT Background Metoclopramide is a commonly used drug in the emergency department for managing nausea, vomiting and migraines. There are currently no reported studies of the rates of metoclopramide‐induced akathisia in the emergency department. Aim To determine the risk and severity of metoclopramide‐induced akathisia. Method This was an observational study of emergency department patients who were administered metoclopramide parenterally and matched controls who were administered parenteral medications not known to cause akathisia (e.g. normal saline or antibiotics). Akathisia was assessed by a blinded interviewer at least one hour after drug administration, using a modified version of the Prince Henry Hospital Akathisia Rating Scale. Results 232 patients were enrolled, 26 were excluded due to missing data or protocol violations. 99 were in the control group and 107 in the metoclopramide group. The mean age was 45.4 ± 19.4 years and 109/206 (53%) were male. 18 patients (16.6%, 95%CI 10.5–25.6) who received metoclopramide developed akathisia compared to 9 patients (9.1%, 95%CI 4.5–17.0) who received a control drug; the risk ratio was 1.85 (95%CI 0.87–3.92, p = 0.10). Conclusion This study showed a trend towards an increased incidence of akathisia following metoclopramide administration in the emergency department. As this is a commonly administered drug in emergency departments, staff should be aware of the potential for akathisia to develop and should consider monitoring patients for this adverse effect.