Data supporting the efficacy of metoclopramide are contradictory, and positive results are limited to observations with intravenous administra-tion.104 Application in infants is limited because of severe adverse events that occur quite frequently (in more than 20% of patients) including central nervous system effects and interactions with the endocrine system.104 The adverse effects regarding the central nervous system are mainly related to its dopamine-receptor blocking properties in the substantia nigra, and include extrapyramidal effects (dystonic reactions, irritability) and drowsiness, but also asthenia and sleepiness. Isolated cases of metoclopramide-induced methemoglo-binemia and sulfhemoglobinemia have been reported.104,105 Neuroendocrine side-effects such as galactorrhea do occur.106 Also, metoclopramide has been reported to induce torsade de pointes.107
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