Mixing Reglan with HD can be a bad combination, so I'm starting a different thread on this since it was buried in Rose's post on needing help with her niece.

Previous messages from other thread:

Myrna wrote about Rikki:
First she started on 5 ml of baclofen, pain releif (paracetamol), antibiotic (ciproxin) & then 5ml of diazepam was introduced. These were gradually increased to 20ml per dose in the hope of helping her.

Her body kept having constant spasms, contracting painfully, rocking backwards & forward, shaking uncontrolably, overheating, throwing up. Then she was given esomoprazole, for acid reflux & metoclopromide to speed up the stomach process. As her med doses got higher, her symptoms got worse.

As it turned out, the biggest culprit was giving baclofen & diazepam together. So I always seperate them by two hours at least. I also never take the risk of giving any other meds with/at the same time as those two as she did react with a cold remedy & baclofen. It took weeks, but I gradually lowered her doses to try her on some diffferent meds, but discovered that she was much better on the lower doses.

Vomitting is still a problem but she is having a J tube fitted tomorrow & i'm hoping that will deal with the sickness & that she will have some respite from the way she has been the past few months.
So fingers crossed for her.

Marsha responded with:
Oh my goodness! I didn't realize that Rikki was on metoclopramide (Reglan)! I just checked and you didn't list it in your email to me in May. That drug is a potent dopamine antagonist which has can have extrapyramidal side effects such as involuntary movements and cause depression. Phds can react very badly to it (in one case I know of it precipitated a psychosis) and younger patients tend to be more likely to have the extrapyramidal side effects. I know that Parkinson's patients are warned against taking it and I think HD patients should be as well.

Myrna responded:
Arghhh. It's so infuriating. I wish I could find a way of checking all meds before I allow the doctors to give them to her.

When Rik first started on metoclopromide, she was on it once a day. But then our HD specialist??? told me she should be on it 3 times a day.

I can't say that I found she was depressed. I think she may be past that satage? And fortunatly, the only time she has been physchotic was before I lowered the doses of the other meds & when they took her into hospital & gave her morphine, that made her worse.

But I took her off metoclopromide 2 weeks ago, because I felt that it was making the sickness worse.
They now have her on one called 'stemetil'. do you know anything about that one....as well as a new antibiotic called amoxiclav.

She certainly isn't as good this week & today she is worse than she has been for a while. I suppose it could be down to lack of calories as she has been on less than 1000 a day for the past week & is growing week & thinner.

Marsha responded:
Stemetil is also a dopamine antagonist and is often prescribed in the UK to treat schizophrenia.
Here's the information: [www.netdoctor.co.uk]

That's not to say that dopamine antagonists shouldn't be prescribed to people with HD. Tetrabenazine is one and some folks do very well on it. But my experience has been that the doctors prescribing drugs like Reglan or Stemetil are not aware of the special risks of side effects in HD patients and HD families naturally think that these drugs affect the stomach and do not know to suspect these drugs when there are increased involuntary movements, a change for the worse in psychiatric condition and/or restlessness.

Myrna responded:
Marsha, thank you so much. I suspected that stemetil was having an effect. I can't explain it...I wish I could, but I can tell when a med has an effect on her brain. They started her off on 5 mls & immediatly she started 'reacting'. I took it on myself to lower it to 3mls, as I find 3ml works better for her with baclofen.

I have just printed the info off so I can show it to the hospital (I have to take her back in tonight ready to have the j tube fitted in the morning). The information shows that it can have effects with codiene, diazepam & baclofen.

I can't tell you how many times I tried to tell the doctors & nurses, the way medication can effect her, when she was in last week. They didn't take any notice of me, infact I sensed that they resented the fact that I knew something they didn't. Or they just didn't want to know.

At one point in Kelly's care one of the Hospice nurses ordered Reglan for Kelly without asking me. The rule in my house was nothing went into Kelly's mouth until I investigated the drug. When I read about the scary potential side effects from Reglan [like tardive dyskinesia and Neuroleptic malignant syndrome], I wouldn't allow hospice to give it to her!!!

Everytime I hear someone is on Reglan, I send this RED FLAG message:

Families of Huntington's Disease patients should exercise caution when this medication is prescribed, especially for those on feeding tubes. Discuss any concerns about a person with Huntington's taking this medication with the physician. If the decision is made to put your loved on Reglan, special attention should be made to look for the serious side affects and report them to the doctor as soon as possible.



Reglan
Generic name: Metoclopramide hydrochloride

Reglan increases the contractions of the stomach and small intestine, helping the passage of food. It is given to treat the symptoms of diabetic gastroparesis, a condition in which the stomach does not contract. These symptoms include vomiting, nausea, heartburn, feeling of indigestion, persistent fullness after meals, and appetite loss.

Symptoms of Gastroesophageal Reflux
The usual dose is 10 milligrams to 15 milligrams of Reglan, up to 4 times a day, 30 minutes before each meal and at bedtime, depending upon the symptoms being treated and the effectiveness of the dose. Treatment usually lasts no longer than [KEY WORD}12 weeks. Reglan is not recommended for patients under 18 years of age.

In other words, Reglan is not a long-term use drug or one for children!

Wikipedia [en.wikipedia.org]
Metoclopramide is commonly used to treat nausea and vomiting (emesis) associated with conditions including: emetogenic drugs, uraemia, radiation sickness, malignancy, labor, and infection. It is also used by itself or in combination with paracetamol (acetaminophen) for the relief of migraine. It is considered INeffective in postoperative nausea and vomiting (PONV) at standard doses, and INeffective for motion sickness. In nausea and vomiting associated with cancer chemotherapy, it has been SUPERCEDED by the more effective 5-HT3 antagonists (e.g. ondansetron).

Common adverse drug reactions (ADRs) associated with metoclopramide therapy include: restlessness, drowsiness, dizziness, and/or headache. Infrequent ADRs include: extrapyramidal effects (EPSE) such as oculogyric crisis (and other acute dystonic reactions), hypertension, hypotension, hyperprolactinaemia leading to galactorrhoea, diarrhoea, constipation, and/or depression. Rare but serious ADRs associated with metoclopramide therapy include: agranulocytosis, supraventricular tachycardia, hyperaldosteronism, neuroleptic malignant syndrome and/or tardive dyskinesia.

The risk of EPSEs are increased in young adults (<20 years) and children. Such dystonic reactions are usually treated with benztropine or procyclidine. The risk of tardive dyskinesia and EPSE is increased with high dose therapy and with prolonged use. Tardive dyskinesias may be persistent and irreversible in some patients.

ENOUGH TO SCARE YOU YET?

Metoclopramide is classified as an anti-emetic (anti-vomiting) drug. It blocks the chemical dopamine in parts of the brain to provide a central anti-vomiting effect. It also stimulates the contraction of the stomach and of the upper portion of the small intestine. These actions occur without stimulating secretions of digestive enzymes. Metoclopramide also increases the pressure at the lower esophageal sphincter. This can reduce or prevent stomach acid from entering the esophagus (a condition called gastro-esophageal reflux). The drug is also used to stimulate stomach and intestinal motility when these motions are abnormally reduced.

Sounds good huh?

FDA on Reglan: [www.drugs.com]
In pediatric patients, the pharmacodynamics of metoclopramide following oral and intravenous administration are highly variable and a concentration-effect relationship has not been established. Safety and effectiveness in pediatric patients have not been established except as stated to facilitate small bowel intubation. The safety profile of metoclopramide in adults cannot be extrapolated to pediatric patients. [KEY WORDS} Dystonias and other extrapyramidal reactions associated with metoclopramide are more common in the pediatric population than in adults.
Metoclopramide should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

Gastrointestinal: Nausea and bowel disturbances, primarily diarrhea. [HMMM, it's supposed to help nausea but causes it?]

One HD Family Experience

My husband had a period of projectile vomiting the summer of 1999. After some tests, it was thought to be a hiatal hernia and acid reflux. He was given the medication reglan. After only 3 weeks on Reglan, he became a changed person. He went from an easy going happy guy to a monster. He experienced hallucinations, paranoia..and too many things to list. After one really bad night, I had to call 911 and he was taken by ambulance to the hospital. As soon as the neurologist on call saw his med list and that he had HD, she said "It is the reglan. Stop it NOW"

He spent one week in hospital and then came home...not a lot better. Two months later he tried to commit suicide and kill me too. Again, the drs. said it had to be from the reglan. They told me it could take 6 -8-9 months to get out of his system. After I researched the drug I found where it states it should not be prescribed for patients with movement disorders or seizures and he had both. It is now July 2000 and my husband still has not improved. His condition has much worsened, most of which can be contributed to giving Reglan to someone with HD.

-----------------
NON HD related:
Last year my BIL, who was recently diagnosed with untreatable lung cancer [and didn't even know he had it] had been admitted to Hospice for a weekend med adjustment to see what might help him keep food down. My kid sister had never been through having anyone really sick but had remembered my words of warning to ALWAYS check out every medication before putting it in your mouth. This was the day before I was leaving for the convention when I went down to see how they were doing. She was worried, hospice was prescribing several meds and she asked me to look them over. Two were non-threatening, but the 3rd was Reglan and my 'dander' went up because although he was never diagnosed Chris had some kind of neurological palsy condition and I expressed my concern.

We cornered the Hospice doctor and I questioned why Reglan was being considered and explained the issues I had with this drug being given to someone with a neurological conditon. She actually said "Thank God someone knows something about this med! It's the drug of choice in Hospice patients who are having gastro problems but shouldn't really be used long-term." At that time we didn't know how serious Chris was, sadly he died that weekend.


Here's a parent forum on infant reflux disease raising this question:

Reglan (Metoclopramide)- scary and dangerous or helpful and needed?
[www.infantrefluxdisease.com]

Patients Experiences - Reglan
[www.medications.com]

That site is also a good place to look up other medications:
Medications.Com your online medication discussion resource
[www.medications.com]

Anyone else have any personal experiences using Reglan with HD? Please post them here!

Love
Jean

PS - I know, I know, we can't all be expected to look up every single drug or believe that every side-effect listed will happen. I get hell for doing that all of the time from my friends. I DO realize that most medications will help whatever they're being prescribed for. When you're feeling sick enough, you'll probably take anything prescribed for you. I was just diagnosed yesterday with bronchitis, pneumonia and a sinus infection that I brought back from Oklahoma a month ago and let go too long. Not being able to breath, having no energy and feeling lousy I took a shot of steroids without question, used the sample inhaler Proventil the doctor gave me immediately and had the prescription for Azithromycin antibiotic filled immediately....anything to be able to breath again! However, after reading the fine print on the inhaler this morning, I've stopped taking it LOL

With my experiences with Kelly I DO know that physicians and nurses don't always consider [a] potential side effects when they're thinking of short-term results; [b] sometimes order wrong meds that could kill you when taken with other meds you're on [which is why you should make ONE doctor responsible for all medications given to you] and [c] almost NEVER revisit a medication they've prescribed for you! If you read about any medication, none are meant for LONG term use!!

Just thought I'd add that all antipsychotics (like haloperidol, risperidol, olanzepine etc.) decrease dopamine (dopamine antagonist effect), as does tetrabenazine (it is a dopamine antagonist and also blocks some other neurotransmitters as well) and this drug is used for treatment of chorea. The reason why these drugs should be avoided in Parkinson's (PD) patients is because with Parkinsons, the problem is that the brain has low levels of dopamine. Parkinson's Disease is treated with dopamine agonists (that increase dopamine) so by giving these patients a dopamine antagonist, it will work in opposition to their PD drugs and worsen their PD symptoms.

Do patients with HD have lower dopamine in their brain? I was not aware of this, but then again I learn something new about hd almost daily.



Edited 2 time(s). Last edit at 07/17/2007 09:18PM by kelver1.