Intravenous Use of Metoclopramide and Sustained Hypotension: A Case Report

Introduction: Transient hypotension has been commonly associated with metoclopramide hydrochloride, particularly with intravenous use. However, the risk of sustained hypotension that lasts for hours has not been previously associated with metoclopramide, except for one published case report. This case report is aimed at documenting the second case of unusual and serious sustained hypotension that lasted for more than six hours following rapid intravenous use of metoclopramide prescribed for the prevention of cesarean section delivery related intra/postoperative nausea and vomiting. Case Report: A 33-year-old gravida III and para II woman was admitted to a hospital for an elective cesarean section delivery with normal baseline blood pressure. Following metoclopramide 10 mg intravenous push administration, over 5-10 seconds, the mother encountered sustained hypotension (60/40 mmHg) that lasted for 120 minutes. After resuscitation, her blood pressure raised to 105/60 mmHg. However, after spinal anesthesia with bupivacaine hydrochloride, her diastolic arterial blood pressure dropped back again to 40 mmHg which persisted for about six hours post-operation. Upon investigation, the sustained hypotension was found to be probably related to inappropriate and rapid administration of intravenous bolus dose of metoclopramide hydrochloride that could have been prevented since it should be administered slowly over at least three minutes. Conclusion: The risk of metoclopramide-induced hypotension should not be underestimated as it sometimes might be much severe than the risk of nausea and vomiting that warrants immediate attention from healthcare professionals and program managers.

Keywords:

Cesarean delivery , Intravenous use , Medication error , Metoclopramide hydrochloride , Sustained hypotension