Risk For Ischemic Stroke Might Increase Briefly After Starting Metoclopramide

Centrally acting antidopaminergic antipsychotics confer risk for ischemic stroke, especially in older patients and those with dementia, with greatest risk in the first month of use. Peripherally acting, nonantipsychotic antidopaminergic antiemetics (ADAs; e.g., metoclopramide) sometimes are prescribed for short-term management of nausea and vomiting or for longer-term management of diabetic gastroparesis. Do these agents also confer risk for ischemic stroke?

In a crossover case-control study using a French national health insurance database, investigators identified 2800 patients who had a first ischemic stroke and had started an ADA (i.e., metoclopramide, domperidone, or metopimazine — the latter two are not generally available in the U.S.)…