I have an 84 year old pt. Dx: NIDDM, S/P MI, BKA R Leg, PVD, Anxiety, Reflux, HTN
Meds:
Neurontin
Protonix
Reglan
Isordil
Glucotrol
Xanax
Percocet PRN
Celexa
He has recently been exhibiting tardive dyskinisia-like symptoms. Sticking out tongue, making weird shapes with his mouth, clicking his teeth, sniffling a lot. He also claims to have severe pain in his jaw. More or less he looks like he wants to jump out of his skin with anxiety, but then again he even does this in his sleep. He's been seen by all depts. and no one can figure out the problem. His xanax (0.25mg) was upped to QID from BID with no change. Also, his Neurontin was D/Cd shortly before these symptoms appeared and he was put back on 4 days ago again with no change. I have been taking care of this man for almost 1 1/2 years and have never seen him like this. Other than the aforementioned, there have been no med changes. This all started about 3 weeks ago with his complaining of a sore throat and tongue.
I would appreciate any suggestions as he is at his wits end and I feel so bad for him.
What you described is EXACTLY how I felt (complete with the tongue movements) after taking my 3rd dose of REGLAN. MD prescribed it to increase gastric emptying. I was completely miserable, the only way to get rid of it was to let the Reglan get out of my system. I feel incredibly bad for your patient...it is one of the worst feelings I have ever experienced. STOP THE REGLAN! This happened about 2 months ago. Let me know if you have other questions...I hope this helps.
NICU_Nurse Wow! Thank you for all the info. I will definitely mention these things to the doctor tomorrow. He is on the neurontin for phantom pain due to the the BKA.
glasgow...thanks as well. No recent weight change and he has tons of labs drawn monthly. No major changes in any of those values.
sjoe...he did go to the VA medical center, odd you should mention that! He went about 4 days ago since he was getting no answers from our house docs. The doc there didn't even send any info back with him and the pt. told me that they gave him 4 shots in the arm?!?! He couldn't tell me what they were though. At the moment, our medical director is trying to get info from their medical director about what went on!
What a bizarre scenario this all is. I just hope for his sake that someone can help him find relief.
Once again, thanks to all for your replies :)
BrandiRNq...sheesh! That is terrible. Reglan doesn't seem a very 'friendly' drug! Glad you found out what was wrong and were able to reverse it!
Had a patient with TD before years ago. The docs discovered it was brought on by Reglan the patient was on. Hope the docs find out what is wrong with your patient. Tell the docs about the Reglan. Take the patient off of it and see if he doesn't improve. :)
Ok...Doc D/Cd Neurontin, Reglan & Protonix today. Also D/Cd PRN Mylanta and Tylenol although he doesn't take those very often. We'll see what happens. He decided to just D/C all unnecessary meds and wait it out a while. Thank you all for you replies and shared concern for my patient. I'll let you know what happens. Boy, if I see any new orders for Reglan on any of my pts. I am going to scream! I never knew all this stuff about it!
Hmmm......I have been a psych nurse for several years...usually you see EPS symptoms like tarditive dyskinesia and akathesia with drugs like haldol,or prolixin....esp if they are deconate drugs.Would your MD be receptive to you requesting a drug like cogentin?if you think he has developed these d/t drug therapy.But usually once they start it is usually not easily revised
The scenario you described sounds like a porblem that is happening everywhere. Reglan (metoclopramide) is famous for causing these symptoms, even after years of being used successfully. Is the Reglan being used for GI problems or is it being used a mild antidepressant/anti-OCD? Either way, there are better alternatives.
I picked up a case in a group home where the Reglan was being used to help a middle aged woman combat her compulsive nature, instead, after months of use, it caused her movements to be rigid, her stomach more upset, chronic constipation, major loss of weight, as well as a host of T/D symptoms. The docs said she was dying---it took an RN to say "let's try taking her off of Reglan" to get this woman to be a part of her own life again.
I hope you let us know how he is doing. I am a psych nurse. Foremost and always the medical has to be checked out first then you move on to the psych part. Reglan has all of the side effects that your pt is exhibiting. There is another potential life threatening side effect mentioned. NMS Neuroleptic Malignant Syndrome. The patient may exhibit muscle rigidity, high fever altered level of consciousness which could lead to death. I have seen this condition happen in a patient when I worked in a state psych hospital. This is a life threatening situation! He was taking mellaril at the time. I know alot of nurses give psychotropics on a regular basis to patients especially the elderly. You need to be aware that these drugs are dangerous and have to be monitored closely. I congradulate you that you were concerned enough to keep asking questions about something you didn't know about. That is what makes a great nurse!!!!!!
TNNURSE...The docs are pretty receptive to oiur suggestions. I'll see what he says about that. Actually, today he was doing a little bit better. Seemed a little calmer and he said his jaw didn't hurt as much. Also, the movements in his face weren't so severe. I don't know if this was just a good day, or the meds being D/Cd helped already? I guess we'll have to wait and see. I believe we're going to have a team meeting on him during the week. Hopefully this can get resolved.
You guys are all so awesome. I am so grateful to have found this community!! Thanks again!
Sadly, over 3 months later my patient is STILL suffering with this! I do not understand doctors and I wish I could do more to help this man. The facial movements have now overtaken his whole body. The poor thing is so miserable and still no answers. I had a neurologist call it TMJ...yes, TMJ!! He went back to the VA where he was diagnosed with sinusitis...yes, sinusitis!! He started having difficulty swallowing liquids so he was sent for a swallow eval. The speech pathologist there called me and asked what in the world was wrong with my pt. causing these movements and I told her it was undiagnosed. She said that she and a few colleagues thought it was some type of chorea. Does anyone here know if that sounds right? I am desperate at this point. If this were my family member I'd take him to the best, but in this case I feel my hands are tied. I don't have much experience in this area so any help would be appreciated.
BrandieRNq
42 Posts
What you described is EXACTLY how I felt (complete with the tongue movements) after taking my 3rd dose of REGLAN. MD prescribed it to increase gastric emptying. I was completely miserable, the only way to get rid of it was to let the Reglan get out of my system. I feel incredibly bad for your patient...it is one of the worst feelings I have ever experienced. STOP THE REGLAN! This happened about 2 months ago. Let me know if you have other questions...I hope this helps.