More on Reglan, Octamide and Maxolon

Some have emailed asking what is Metoclopramide.

Metoclopramide is used to treat the slow stomach-emptying that can occur in diabetes, and as a second-line treatment for heartburn caused by gastroesophageal reflux. It's sometimes used for the nausea and vomiting that accompany cancer treatment, and migraines.

Regulan or its generic stimulates the stomach to move things along, reducing fullness and reflux of the stomach's contents. It also quashes the urge to vomit. It works by blocking dopamine, a neurochemical that induces vomiting and stomach-slowing.

What is TD?

Tardive dyskinesia is a disorder in which the tongue, mouth and jaw move uncontrollably in abnormal ways. Movements can include eye-blinking and face-jerking, and can occur elsewhere on the body. The movements are "pretty much constant," says Dr. Jeff Bronstein, a neurologist at UCLA's David Geffen School of Medicine, except during sleep.

The disorder can persist for months and years, and in some cases appears to be permanent. Severity can vary, Bronstein says. "Some people can get so bad it's hard for them to eat and swallow because of their tongue movements. And obviously, cosmetically, it's horrible."

Tardive dyskinesia occurs as a side effect of drugs that block dopamine. Once diagnosed, patients are usually taken off the drug. In some patients, the symptoms get better. In many cases, it becomes a permanent neurological disorder. No standard therapy exists, but various drugs have been used as treatments.

How big is the risk?

Jankovic analyzed all 443 tardive dyskinesia patients seen over 25 years at his Baylor clinic. Prior to 2000, the antipsychotic Haldol was the main culprit; since then, metoclopramide has moved to first place.

"It is a public health problem," Jankovic says. "Many of these patients who have metoclopramide-induced movement disorders aren't recognized until . . . they're at pretty advanced stages of the disease."

The main way to limit the risk is by limiting how long the drug is used. The drug is already labeled for short-term use, defined as four to 12 weeks. But a 2007 FDA study found that 20% of patients were prescribed the drug for longer than this.