Respiratory failure following oral administration of metoclopramide

OBJECTIVE: To report a case of respiratory failure, possibly due to anaphylaxis or asthma exacerbation, following the administration of metoclopramide. CASE SUMMARY: A 32-year-old white woman with a history of severe asthma and short-bowel syndrome was admitted for Hickman catheter line sepsis. Two doses of oral metoclopramide 10 mg in solution were administered for nausea and vomiting. Transient dyspnea followed the first dose of metoclopramide, but respiratory failure requiring intubation followed the second dose. DISCUSSION: Respiratory failure has been reported with metoclopramide-induced movement disorders. Three other cases of respiratory failure from anaphylaxis or asthma exacerbation following metoclopramide administration have been reported. Respiratory failure in our patient may be due to anaphylaxis or bronchoconstriction from metoclopramide-induced cholinergic activity of the vagus nerve, possibly through inhibition of acetylcholinesterase. CONCLUSIONS: The use of metoclopramide in patients with pulmonary dysfunction may warrant caution.