Clinical Psychiatry News - Metoclopramide may suppress Tourette’s tics
DENVER — The dopamine receptor antagonist metoclopramide shows potential as a tic suppressant in patients with Tourette’s syndrome according to a small preliminary study, Dr. Maria T. Acosta reported at the annual meeting of the American Academy of Neurology.
Metoclopramide uniformly suppressed tics with negligible adverse effects in an open-label series of 10 patients. During 3-22 months of follow-up, their Yale Global Tic Severity Scale scores improved by a mean of 55%.
If this early promise of clinical utility is ultimately confirmed in an ongoing larger double-blind, placebo-controlled trial, physicians may gain a useful new therapeutic option for Tourette’s syndrome, according to Dr. Acosta of the Children’s National Medical Center, Washington.
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Both typical and atypical antipsychotic agents generally are highly effective at suppressing tics. Their usefulness, however, is severely limited by numerous adverse effects, including cognitive dulling, anxiety, depression, and affective flattening.
Since patients with Tourette’s syndrome do not have psychotic symptoms, a more specific therapy would be welcome, Dr. Acosta said.
Although metoclopramide usually is thought of as a gastric motility agent, it is classified as a neuroleptic but is seldom used in psychiatric practice.
Even at a substantial dose of 1,000 mg/day, the drug is only minimally effective at reducing psychotic symptoms.
Metoclopramide has a propensity to produce extrapyramidal side effects but seems to be relatively sparing of cognitive and prefrontal circuits. This striking anatomic selectivity is what led Dr. Acosta and her associates to consider metoclopramide as a potential tic-suppressing agent with possible advantages over the typical and atypical antipsychotics.
The drug was well tolerated in the open-label study Nine of the 10 patients were younger than 18 years of age.
They were titrated to a mean effective dose of 39.5 mg/day given b.i.d. or t.i.d. At that dose, side effects consisted of transient sleepiness in a total of four patients.
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