Patients receiving long-term metoclopramide treatment are at risk for tardive dyskinesia. Tardive dyskinesia is one of the clinical manifestations of drug-induced movement disorders along with akathisia, dystonia and parkinsonism. It is a hyperkinetic movement disorder characterized by involuntary, repetitive movements of the extremities, or lip smacking, grimacing, tongue protrusion, rapid eye movements or blinking, puckering and pursing of the lips, or impaired movement of the fingers. One study of 125 patients presenting for drug-induced movement disorders revealed 63% had tardive dyskinesia, 30% parkinsonism, 24% dystonia and 7% akathisia.
Drugs that block dopamine receptors, such as antipsychotics, have been associated with these adverse effects, but the association with anti-emetics such as metoclopramide and prochlorperazine has been less well-recognised.
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