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The antiemetic properties of metoclopramide appear to be a result of its antagonism of central and peripheral dopamine receptorsDopamine produces nausea and vomiting by stimulation of the medullary chemoreceptor trigger zoneCTZand metoclopramide blocks stimulation of the CTZ by agents like ldopa or apomorphine which are known to increase dopamine levels or to possess dopamine-like effectsMetoclopramide also abolishes the slowing of gastric emptying caused by apomorphine.

There have been rare reports of an uncommon but potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant SyndromeNMSassociated with metoclopramideClinical manifestations of NMS include hyperthermiamuscle rigidityaltered consciousnessand evidence of autonomic instabilityirregular pulse or blood pressuretachycardiadiaphoresis and cardiac arrhythmias

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