What factor increases the risk of extrapyramidal symptoms with metoclopramide in older adults?

• A. Prolonged exposure
• B. Short-term use
• C. IV administration
• D. Co-administration with laxatives

Answer: (A)

Prolonged exposure to metoclopramide increases the risk of extrapyramidal symptoms in older adults. Metoclopramide blocks dopamine D2 receptors in the brain, and extended blockade, especially in the nigrostriatal pathways, can lead to motor side effects such as acute dystonia, parkinsonism, and tardive dyskinesia. Older patients are more susceptible due to age-related changes in drug metabolism and increased CNS sensitivity, so the total duration and cumulative dose matter more in this group. Short-term use or routes of administration by themselves don’t carry the same elevated risk, and co-administration with laxatives doesn’t impact EPS risk.