Menu
Job Title
Psychiatry Resident
Academic Rank
N/A
Department
Psychiatry
Authors
Nichola Haddad, MD, Marlee Madora, MD, Natalie Feldman, MD, Jordan Rosen, MD
Principal Investigator
Nichola Haddad, MD
Categories
Tags
Background: Despite metoclopramide being widely used to treat nausea and to increase milk supply in women with lactation difficulties, it may have adverse psychiatric effects in some patients. This case series describes three perinatal women who experienced worsening psychiatric symptoms in the context of metoclopramide use.
Case 1: A 43-year-old woman was hospitalized multiple times for severe hyperemesis gravidarum during pregnancy. She was trialed on metoclopramide and subsequently developed suicidality, worsening mood and psychotic symptoms requiring psychiatric hospitalization.
Case 2: A 35-year-old woman developed near-daily migraines during pregnancy. She was started on metoclopramide and noticed improved migraines but worsening mood.
Case 3: A 40-year-old postpartum woman was started on metoclopramide to increase milk supply. Seven weeks later, she endorsed worsening anxiety, depression, insomnia, obsessive-compulsive symptoms.
Conclusions: Metoclopramide is FDA-approved to treat gastrointestinal reflux disease and diabetic gastroparesis, but providers use it for various medical indications. These cases demonstrate that metoclopramide use amongst women may lead to worsening mental health outcomes. Perinatal women are a particularly high-risk group. We thus suggest that in this population, metoclopramide should be used with caution, not as a first-line agent, and with extra care in patients with psychiatric histories.
Background: Despite metoclopramide being widely used to treat nausea and to increase milk supply in women with lactation difficulties, it may have adverse psychiatric effects in some patients. This case series describes three perinatal women who experienced worsening psychiatric symptoms in the context of metoclopramide use.
Case 1: A 43-year-old woman was hospitalized multiple times for severe hyperemesis gravidarum during pregnancy. She was trialed on metoclopramide and subsequently developed suicidality, worsening mood and psychotic symptoms requiring psychiatric hospitalization.
Case 2: A 35-year-old woman developed near-daily migraines during pregnancy. She was started on metoclopramide and noticed improved migraines but worsening mood.
Case 3: A 40-year-old postpartum woman was started on metoclopramide to increase milk supply. Seven weeks later, she endorsed worsening anxiety, depression, insomnia, obsessive-compulsive symptoms.
Conclusions: Metoclopramide is FDA-approved to treat gastrointestinal reflux disease and diabetic gastroparesis, but providers use it for various medical indications. These cases demonstrate that metoclopramide use amongst women may lead to worsening mental health outcomes. Perinatal women are a particularly high-risk group. We thus suggest that in this population, metoclopramide should be used with caution, not as a first-line agent, and with extra care in patients with psychiatric histories.
