Haloperidol/metoclopramide

Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a case series, two women aged 20 and 68 years were described, of whom, one woman developed oculogyric crisis during treatment with metoclopramide for nausea, and the other woman developed oculogyric crisis during treatment with haloperidol for delirium [not all dosages, routes and duration of treatments to reaction onsets stated].

Patient A: The 20-year-old woman was admitted with lymphoblastic lymphoma. She was treated with vincristine, daunorubicin and methotrexate. At that time, she was found have a fixed eye position to the upper right with an intact consciousness. Hence, neurologist was consulted. She was unable to move her eyes properly for an hour. Her eyes remained pointed to the top right. On investigation, it was note that she had received IV metoclopramide an hour before the onset of the symptoms due to nausea. On neurological examination, she was found to have an intact consciousness. Her pupils were isochoric and responsive to light. At rest, there was a conjugated eye position to the top right. With a conjugated eye position, both eyes were simultaneously in the same direction. She was able to perform the eye tracking movements in all directions with some difficulty. Based on her complaints, a diagnosis of metoclopramide-induced oculogyric crisis was made. Therefore, she was treated with biperiden. Within a few minutes, her symptoms improved. Furthermore, metoclopramide was stopped. The complaints did not occur after one dose of biperiden.

Patient B: The 68-year-old woman was admitted to the emergency department due to an increase in dyspnoea in severe heart failure, restrictive lung function and obesity. At admission, she was treated with nitroglycerin and ipratropium bromide/salbutamol. Her home medications included haloperidol in addition to multiple concomitant drugs. On admission, she reported that she had impaired vision for several hours. The doctor found a normal vision, but an abnormal eye position. Thus, neurologist was consulted. On neurological examination, she was found have a clear consciousness. Her pupils were isochoric and responsive to light. At rest, there was a conjugated eye position to the upper right. Upon request, she was able to move her eyes to other directions for a short time and there was no diplopia. Based on her symptoms and neurological examination, oculogyric crisis was suspected. Three months prior to the admission, she had developed COVID-19 infection, complicated by delirium, for which haloperidol was initiated. Since then, she had been using alternating haloperidol in nocturnal unrest. Two days prior to the admission, she had re-started haloperidol at a dose of 2mg spread over the day. Hence, haloperidol-induced oculogyric crisis was suspected. Haloperidol was stopped and she was treated with biperiden. Subsequently, her symptoms improved. After 30 minutes, a second dose of biperiden was given, after which she remained free of complaints.