Prevalence of Chronic Metoclopramide Use and Associated Diagnoses in the US Pediatric Population

OBJECTIVE: Metoclopramide is the only medication widely used to promote gastrointestinal motility in the USA. Despite its appreciable risk of central nervous system complications, it continues to be prescribed to children for chronic use. We sought to estimate the prevalence of chronic metoclopramide use among US children and identify the diagnoses that may have prompted this use. The US metoclopramide label lists only two indications in adults: symptomatic gastroesophageal reflux (GERD) and diabetic gastroparesis. The latter is rare in children so, in examining the indications likely to have prompted chronic metoclopramide use, we focused on GERD. METHODS: From two health services databases representing privately and publically insured children, respectively, we estimated the number of US children who used metoclopramide chronically and identified the diagnoses recorded at approximately the time when the chronic use began. We defined chronic use liberally as ≥35 days’ supply, or conservatively as ≥130 days’ supply in a 6-month period. For each chronic-use definition, insurance type, and age group, we estimated the proportion of children using metoclopramide chronically. We applied these proportions to US population estimates. RESULTS: Under the liberal and conservative definitions, respectively, 89,020 and 28,222 US children used metoclopramide chronically. CONCLUSION: In spite of its risk, substantial numbers of US children use metoclopramide chronically for symptoms suggestive of GERD. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40272-015-0136-2) contains supplementary material, which is available to authorized users.