Although a black box warning for tardive dyskinesia was announced by the FDA in February 2009, lawsuits filed against the makers of Reglan (metoclopramide) allege the drug companies knew for decades that the risk of movement disorders was much greater than acknowledged in previous labels.
According to an expert witness report filed in a Georgia lawsuit by Dr Robert Nelson, a former 20-year employee of the FDA and National Institute of Health, "the 1/500 EPS labeling was inaccurate and misleading from the moment the oral dosage form was approved."
In citing a 2008 study on the causes of TD at a university-based movement disorder clinic, Nelson reports that from 2000-2006, metoclopramide induced TD "was more common than any other cause, accounting for 34.5%" of all cases, or 87 out of 250.
Reglan is approved only for the short term treatment (12 weeks max) of gastroesophageal reflux disease (GERD), in adults who have not responded to other therapies, and for diabetic gastroparesis, for two to 8 weeks.
In the February 2009, letters notifying the drug makers of a need for a black box, the FDA stated, "we have become aware of continued spontaneous reports to the FDA of tardive dyskinesia associated with metoclopramide use. Exposure greater than 12 weeks was evident in a majority of these reports."
In fact, a telephone survey conducted, by then Reglan maker (AH Robins), back in 1985, "found that 38% of Reglan users took the drug for between one and two years and another 46% of Reglan users took the drug for three to six months," Dr Bob West, a pharmacologist and toxicoligist, says in a report filed in a Louisiana lawsuit.
Tardive dyskinesia is one of the most devastating of all drug-induced movement disorders, according to Dr Peter Breggin, author of about twenty books, including "Medication Madness."
"The abnormal movements or spasms can strike any of the muscles that are under voluntary control, including muscles of the face, eyes, mouth, tongue, neck, shoulders, arms, legs, hands, and feet," he says. "Breathing, speaking, and swallowing can also be impaired."
"Tardive dyskinesia often looks so "strange" or "bizarre" that it is mistaken for a mental illness rather than a neurological disorder," he notes.
Reglan can also cause uncontrolled muscle spasms (dystonia), Neuroleptic Malignant Syndrome, Parkinsonism, depression, thoughts of suicide, and suicide. Common side effects include feeling restless, sleepy, tired, dizzy, or exhausted, headache, confusion, and trouble sleeping, according to a June 9, 2009, FDA approved medication guide.
Pregnant Women Targeted
Four months after the black box for TD was announced, a New England Journal of Medicine study claimed that Reglan was safe for pregnant women with morning sickness.
The news of the study was sent out to all the media outlets and a massive off-label marketing campaign followed to promote the sale of Reglan to pregnant women, with journalists publishing almost identical talking points.
Reporter, Linda Johnson, put out articles through the Associated Press newswire which resulted in headlines such as, "Study Suggests Drug Is Safe For Morning Sickness," popping up all over the internet and for major media stories for a couple weeks.
For instance, in a June 10, 2009, article that appeared in USA Today, on Fox and ABC news Websites, and even in the UK's Guardian on June 12, 2009, Johnson wrote: "For the first time, a large study shows that pregnant women who suffer morning sickness are not risking harm to their babies if they take a certain anti-nausea drug."