This case suggests that metoclopramide-induced akathisia can occur during pregnancy and may be misdiagnosed as a perinatal anxiety disorder. Rapid intravenous bolus administration is a known risk factor for metoclopramide-induced akathisia and may have increased the risk in this patient. In addition, a possible pharmacological interaction between metoclopramide and dextromethorphan, including a potential CYP2D6-related pharmacokinetic effect and central dopaminergic pharmacodynamic effect, may have contributed to akathisia. Greater awareness of this adverse effect may facilitate early recognition and appropriate management.
Nakamura et al. (Tue,) studied this question.