Background In July 2013, the European Medicines Agency (EMA) recommended changes to the use of metoclopramide, including restricting dose (maximum 30 mg/day) and duration (up to 5 days), to minimise the known risks of potentially serious neurological side-effects.
Purpose To evaluate the influence of these recommendations on the prescription pattern of metoclopramide in a tertiary care hospital.
Material and methods The Pharmacy Department communicated the EMA’s recommendations to physicians through an internal-messaging system. Pharmacists revised new prescriptions with metoclopramide in the electronic prescription database, making recommendations, if required, according to the EMA’s advice.
Subsequently, an observational retrospective study was conducted of all prescriptions of metoclopramide during the same week before (March 2013) and after (March 2014) the EMA’s press release. From the electronic prescription database, patient data (age, sex and reason for admission) and posology and duration of treatment with metoclopramide, were recorded and compared with the EMA’s recommendations. Emergency Service and Paediatrics were not evaluated.
Results 213 (51% men) and 225 patients (44% men) with an average age of 59.6 [17–99] and 60.7 [22–93] years old received metoclopramide in the studied weeks of 2013 and 2014, respectively. Reason for admission in 73% and 74% of patients was surgery. 34% and 24% of patients, in 2013 and 2014 respectively, had a fixed-dosing schedule, so the “as needed” schedule was largely selected. Of the patients with a fixed-dose schedule, 44% vs. 46% met the EMA’s prescription recommendations, with no statistically significant difference (p = 0.782, CI = 95%), in 2013 and 2014 respectively. Of these, 34% vs. 46% of prescriptions did not meet therapeutic indication; 27% vs. 22% had a duration in excess of 5 days and 2 patients in 2013 received doses higher than 30 mg/day.
Conclusion In our hospital, the pattern of metoclopramide prescribing has not changed significantly after the EMA’s press release. More needs to be done in order to achieve major compliance.
References and/or acknowledgements EMA recommends changes to the use of metoclopramide.
No conflict of interest.
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