American Board of Internal Medicine (ABIM) Certification Practice Exam

What major side effect is associated with metoclopramide, necessitating its possible discontinuation?

1. Hypersomnia

2. Hyperprolactinemia

3. Weight loss

4. Bleeding

The correct answer is: Hyperprolactinemia

Metoclopramide is primarily used for its effects on gastrointestinal motility and as an antiemetic. One of the significant concerns with its prolonged use is the potential for hyperprolactinemia. This condition occurs due to the drug's antidopaminergic effects—specifically, metoclopramide blocks dopamine receptors in the central nervous system. Elevated levels of prolactin can lead to a variety of symptoms, including galactorrhea, amenorrhea in females, and gynecomastia in males. As a result, hyperprolactinemia can necessitate the discontinuation of metoclopramide therapy due to the adverse effects on hormonal balance and the associated symptoms. Other options reflect side effects that are either less common or not directly linked to metoclopramide in the same way. For example, hypersomnia is not a characteristic or well-documented side effect, and while weight changes can occur with many medications, significant weight loss isn't a commonly reported side effect for metoclopramide. Lastly, bleeding is not a major side effect associated with metoclopramide use. Understanding the specific side effects related to the pharmacological class of a medication is crucial for safe prescribing and ongoing management