Metoclopramide

Brands

DEA Class; Rx

Common Brand Names; Reglan, Metozolv ODT

  • Antiemetic Agents; 
  • Prokinetic Agents

Oral, parenteral, and nasal GI prokinetic agent
Used for diabetic gastroparesis and select adults with GERD; injection helpful for PONV prevention, chemotherapy-induced emesis, and as a procedural adjunct
Use should be kept to 12 weeks or less due to risk for tardive dyskinesia; use in pediatric patients is not recommended except for limited, short-term circumstances

Indicated for post-operative nausea/vomiting (PONV) and post-operative nausea/vomiting (PONV) prophylaxis.

For emetogenic chemotherapy-induced nausea/vomiting and chemotherapy-induced nausea/vomiting prophylaxis.
To facilitate intestinal intubation and for use as a diagnostic aid during gastrointestinal radiography.
For the treatment of symptomatic gastroesophageal reflux disease (GERD).
For the treatment of diabetic gastroparesis or postsurgical gastroparesis.
For the acute treatment of migraine.

Indicated for symptomatic relief in adults with acute and recurrent diabetic gastroparesis

For use as a radiation sensitizer in combination with radiation therapy in the treatment of patients with non-small cell lung cancer (NSCLC).
For the facilitation of gastric emptying in neonates with feeding intolerance.

Hypersensitivity to metoclopramide or procainamide

History of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide

When stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation)

Presence of pheochromocytoma or other catecholamine-releasing paragangliomas

Patients with history of epilepsy

Other drugs causing extrapyramidal symptoms (eg, phenothiazines, butyrophenones)

  • Extrapyramidal symptoms (dystonic reactions in 25% of young adults 18-30 years old)
  • Fatigue (2-10%)
  • Restlessness (10%)
  • Sedation (10%)
  • Headache (4-5%)
  • Dizziness (1-4%)
  • Somnolence (2-3%)

Mental depression reported; use with caution in patients with history of mental illness

Use with caution or avoid in Parkinson disease patients; may have increased risk of extrapyramidal symptoms

Use with caution after GI anastomosis or closure; promotility agents reported to increase pressure in suture lines

Use caution in patients with hypertension, CHF, renal impairment, cirrhosis

Use caution in patients who are at risk of fluid overload

Metoclopramide may cause a potentially fatal symptom complex called neuroleptic malignant syndrome (NMS). NMS has been reported in association with metoclopramide over dosage and concomitant treatment with another drug associated with NMS; discontinue therapy immediately if symptoms occur

Can cause tardive dyskinesia (see Black Box Warnings), especially in elderly; discontinue if signs or symptoms of tardive dyskinesia develop (metoclopramide itself may completely or partially suppress these manifestations); tardive dyskinesia may persist even after drug is discontinued

As with other dopamine D2 receptor antagonists, metoclopramide elevates prolactin levels

Galactorrhea, amenorrhea, gynecomastia, and impotence reported with prolactin-elevating drugs, including metoclopramide; hyperprolactinemia may potentially stimulate prolactin-dependent breast cancer; however, some clinical studies and epidemiology studies have not shown an association between administration of dopamine D2 receptor antagonists and tumorigenesis in humans

May impair mental and/or physical abilities required for performance of hazardous tasks such as operating machinery or driving a motor vehicle; concomitant use of central nervous system (CNS) depressants or drugs associated with EPS may increase this effect (e.g., alcohol, sedatives, hypnotics, opiates, and anxiolytics); avoid drug or the interacting drug, depending on importance of drug to the patient

Diphenhydramine 50 mg IM can be given for extrapyramidal symptoms

Metoclopramide crosses the placental barrier and may cause extrapyramidal signs and methemoglobinemia in neonates with maternal administration during delivery; monitor neonates for extrapyramidal signs

Monitor breastfeeding neonates because metoclopramide may cause extrapyramidal signs (dystonias) and methemoglobinemia

Adults

60 mg/day or 20 mg PO, IV, or IM per single dose and 15 mg nasally per single dose; therapy for more than 12 weeks not recommended by FDA-approved product labeling.

Geriatric

60 mg/day or 20 mg PO, IV, or IM per single dose and 15 mg nasally per single dose; lower dosage may be sufficient in the elderly; therapy for more than 12 weeks not recommended by FDA-approved product labeling.

Adolescents

0.2 mg/kg/dose IV (Max: 10 mg/dose IV) and 0.2 mg/kg/dose PO (Max: 10 mg/dose or 0.8 mg/kg/day PO) have been reported; 2 mg/kg/dose IV infusion has been used for emetogenic chemotherapy.

Children

0.2 mg/kg/dose IV (Max: 10 mg/dose IV) and 0.2 mg/kg/dose PO (Max: 10 mg/dose or 0.8 mg/kg/day PO) have been reported; 2 mg/kg/dose IV infusion has been used for emetogenic chemotherapy.

Infants

0.1 mg/kg/dose IV and 0.2 mg/kg/dose PO (Max: 0.8 mg/kg/day PO) have been most commonly reported.

Neonates

Data are limited; safety and efficacy not established. 0.1 mg/kg/dose IV and 0.15 mg/kg/dose PO (Max: 0.6 mg/kg/day PO) have been reported.

Metoclopramide hydrochloride

injectable solution

  • 5mg/mL

syrup

  • 5mg/5mL
  • 10mg/10mL

tablet

  • 5mg
  • 10mg

Dispersible tablets

  • 5mg
  • 10mg

intranasal solution

  • 15mg/actuation
  • Each bottle contains 9.8 mL
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