{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T21:37:37Z","timestamp":1776202657162,"version":"3.50.1"},"reference-count":49,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T00:00:00Z","timestamp":1529366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>We conducted a cohort study utilizing a nationwide health insurance database to assess the European Medicines Agency's restrictions on using metoclopramide and its association with the risk of parkinsonism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>New oral metoclopramide users aged \u226520\u00a0years, and age\u2010 and gender\u2010matched non\u2010users were recruited between 2001 and 2011. Users were divided into high\u2010exposure (dose &gt;30\u00a0mg day<jats:sup>\u20131<\/jats:sup> and\/or duration &gt;5\u00a0days) and standard\u2010exposure (dose \u226430\u00a0mg day<jats:sup>\u20131<\/jats:sup> and duration \u22645\u00a0days) groups. The adjusted hazard ratio (aHR) with 95% confidence interval (CI) estimated the risk of parkinsonism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a 1\u2010year period, 122 of 218\u2009931 (0.06%) users of metoclopramide <jats:italic>vs<\/jats:italic>. 56 of 218\u2009931 (0.03%) non\u2010users developed parkinsonism (<jats:italic>P<\/jats:italic> &lt; 0.001). Among the 122 cases of parkinsonism in users, 64 (0.04%) were from 168\u2009566 standard\u2010exposure users and 58 (0.12%) from 50\u2009365 high\u2010exposure users. Compared with non\u2010users, the risk of parkinsonism was higher in users (aHR 2.16; 95% CI 1.54, 3.02), including standard\u2010exposure (aHR 1.73; 95% CI 1.11, 2.70), and high\u2010exposure (aHR 3.15; 95% CI 1.78, 5.57) users. High\u2010exposure users had a higher risk of parkinsonism than standard\u2010exposure users (aHR 1.83; 95% CI 1.28, 2.63). Within the high\u2010exposure group, 45\u2009233 of 50\u2009365 (89.81%) users and 55 of 58 (94.83%) parkinsonism were from long\u2010duration exposure; 5\u2009132 of 50\u2009365 (10.19%) users and 3 of 58 (5.17%) parkinsonism were from high\u2010dose exposure and long\u2010duration + high\u2010dose exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of parkinsonism in metoclopramide users, although extremely low (0.06%), is 2.16\u2010fold greater than in non\u2010users. High\u2010exposure users have a 1.83\u2010fold higher risk than standard\u2010exposure users. As users in high\u2010exposure group had a higher risk of parkinsonism than in standard\u2010exposure group, and the majority of users and parkinsonism in high\u2010exposure group were from long\u2010duration exposure; thus, physician are advised to avoid prescribing metoclopramide for &gt;5\u00a0days, even if the daily dose is \u226430\u00a0mg.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.13630","type":"journal-article","created":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T09:55:38Z","timestamp":1525946138000},"page":"2000-2009","source":"Crossref","is-referenced-by-count":13,"title":["High exposure compared with standard exposure to metoclopramide associated with a higher risk of parkinsonism: a nationwide population\u2010based cohort study"],"prefix":"10.1111","volume":"84","author":[{"given":"Shin\u2010Chia","family":"Tsai","sequence":"first","affiliation":[{"name":"School of Pharmacy, College of Pharmacy Taipei Medical University  Taipei Taiwan"},{"name":"Department of Pharmacy, Shuang Ho Hospital Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiow\u2010Yunn","family":"Sheu","sequence":"additional","affiliation":[{"name":"School of Pharmacy, College of Pharmacy Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010Nien","family":"Chien","sequence":"additional","affiliation":[{"name":"School of Health Care Administration, College of Management Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsin\u2010Chien","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Shuang Ho Hospital Taipei Medical University  Taipei Taiwan"},{"name":"Department of Psychiatry, School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"},{"name":"Research Center of Sleep Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunice Jia\u2010Shiow","family":"Yuan","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6680-5600","authenticated-orcid":false,"given":"Rey\u2010Yue","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurology Taipei Medical University Hospital  Taipei Taiwan"},{"name":"Department of Neurology, School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23828"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2013.787065"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3654"},{"key":"e_1_2_10_5_1","first-page":"215","article-title":"Drug\u2010induced Parkinson's disease. 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