Tardive Dyskinesia in Patients Receiving Continuous Versus Intermittent Oral Metoclopramide: A Retrospective Real World Study.

BACKGROUND: Tardive dyskinesia (TD) is an often irreversible movement disorder associated with prolonged exposure to dopamine receptor antagonists such as metoclopramide (MCP). This study evaluates the prevalence and timing of TD in patients receiving continuous versus intermittent MCP. METHODS: A retrospective analysis was conducted using Symphony Health Solutions data from July 2018 to June 2024, covering over 307 million U.S. PATIENTS: Two cohorts were analyzed: (1) all patients with ≥ 2 MCP prescriptions (Cohort A), and (2) patients with a gastroparesis diagnosis (ICD10 K31.84) prior to ≥ 2 MCP prescriptions (Cohort B). TD prevalence was evaluated based on ≥ 1 or ≥ 2 ICD-10 G24.01 claims within 12 months after initial MCP prescription. MCP exposure was classified as continuous (Proportion of days covered (PDC) > = 1) or intermittent (PDC < 1). RESULTS: TD prevalence was higher in patients receiving continuous MCP across both cohorts. In Cohort A (N = 1,360,196), TD prevalence was 0.25% (continuous) vs. 0.18% (intermittent) for ≥ 1 claim, and 0.13% vs. 0.09% for ≥ 2 claims. In the cohort with gastroparesis (N = 125,279), TD prevalence was 0.77% (continuous) vs. 0.55% (intermittent) for ≥ 1 claim, and 0.43% vs. 0.25% for ≥ 2 claims. Median time to TD diagnosis was shorter for continuous users: 567 vs. 758 days in Cohort A and 490 vs. 573 days in Cohort B. All group differences were statistically significant (p < 0.005). CONCLUSIONS: Continuous MCP dosing was associated with higher TD prevalence and earlier onset. Intermittent dosing, despite longer cumulative exposure, was associated with lower TD risk. These findings suggest that intermittent regimens may offer a safer MCP therapeutic strategy.