Reglan and Anti-Psychotics for Migraine? Yup!

You may already be taking an anti-psychotic medication for migraine and not even know it. Reglan, generic name Metoclopramide1, has been gaining popularity in migraine treatment over the past decade, and for good reason2.

Metoclopramide is actually in the same family of dopamine antagonists (Phenothiazines3), as another popular anti-psychotic, Thorazine (generic: Chlorpromazine)4.

Did you know that our gut in many ways is our second brain5? Our digestive track is full of neurotransmitters, it is even believed that the nervous system in our guts can influence mood6.

So it isn’t a huge surprise that some psychiatric drugs can actually help with nausea and other issues with digestion.

Metoclopramide is an odd drug. We know it was developed by Jannsen in the 1960s, and it is likely that it’s initial purpose was to be an anti-psychotic like Thorazine. However, Metoclopramide turned out to have a much stronger effect on Dopamine and Serotonin in the digestive track and limited impact in the brain.

Metoclopramide also works by helping the stomach empty, which is a common problem in migraine. Metoclopramide also can increase the bioavailability of Tylenol and NSAIDS, meaning better pain relief. Though even all by it’s lonesome Metoclopramide has been known to improve migraine nausea AND pain2.

On Thorazine

It has been discovered that low doses of Thorazine (Chlorpromazine)4 can actually have more effect in terms of treating migraine nausea and pain7. However, the side effect risk is a bit higher for Thorazine so Reglan remains a better first line option.

On Tardive Dyskinesia and other Extrapyramidal Symptoms

All dopamine antagonists can cause Extrapyramidal Symptoms (EPS)8. However, EPS symptoms usually resolve within a few days of stopping the drug. EPS is also more likely to develop with long term daily use of a dopamine agonist like Metoclopramide.

Tardive Dyskinesia (TD) is another movement disorder that can be caused by dopamine agonists. TD involves involuntary movements often in the face and tongue. TD actually can be permanent. However, once again it is a rare side effect, and often occurs with regular use. A study has shown that Metoclopramide has a low prevalence of TD9.

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