Metoclopramide

General

• Type: anti-emetic
• Dosage Forms: 5, 10; 5/5 mL; IM; IV
• Common Trade Names: Reglan

Adult Dosing

GERD: chronic symptoms: 10-15mg PO/IM/IV qac and qhs, Max: x12wk; intermittent symptoms: up to 20mg PO/IM/IV x 1 before symptoms

diabetic gastroparesis: 10mg PO/IM/IV qac and qhs, Max: x12wk

nausea/vomiting prevention, chemo-related: 1-2mg/kg IV q2-3h

nausea/vomiting prevention, postop: 10mg IM/IV x 1

small bowel intubation: 10mg IV x 1

radiologic exam: 10mg IV x 1

'palliative medicine: 10mg subcutaneously or orally 6-hourly and/or 30mg via CSCI over 24 hours

Pediatric Dosing

GERD: 0.1-0.2mg/kg PO/IM/IV qid, Max: 0.8mg/kg/24h x 12wk

nausea/vomiting prevention, chemo-related: 1-2mg/kg IV q2-4h

nausea/vomiting prevention, postop: 0.1-0.2mg/kg IV x1

Special Populations

• Pregnancy Rating: B
• Lactation risk: Safety Unknown
• Renal Dosing
  • Adult: CrCl 41-50: decrease dose 25%; CrCl 10-40: decrease dose 50%; CrCl <10: decrease dose 75%; HD/PD: no supplement
  • Pediatric: CrCl 41-50: decrease dose 25%; CrCl 10-40: decrease dose 50%; CrCl <10: decrease dose 75%; HD/PD: no supplement
• Hepatic Dosing
  • Adult: no adjustment
  • Pediatric: no adjustment

Contraindications

• Allergy to class/drug
• pheochromocytoma
• seizure disorder
• GI bleeding or perforation
• GI obstruction
• caution if depression
• caution if Parkinson disease
• caution if NADH methemoglobin reductase deficiency
• caution if hypertension
• caution if CHF
• caution if cirrhosis
• caution if dibetes mellitus
• caution if renal impairment
• caution if neonates
• caution if pediatric patients
• caution if elderly patients, esp. female

Adverse Reactions

Serious

• extrapyramidal symptoms
• dystonia, acute
• parkinsonism
• tardive dyskinesia
• neuroleptic malignant syndrome
• seizures
• depression
• suicidality
• hallucinations
• leukopenia
• neutropenia
• agranulocytosis
• methemoglobinemia
• CHF, acute
• AV block
• SVT
• hypertension
• angioedema
• hepatotoxicity
• withdrawal symptoms if abrupt discontinuation

Common

• drowsiness
• restlessness
• fatigue
• anxiety
• insomnia
• headache
• confusion
• dizziness
• depression
• extrapyramidal symptoms
• galactorrhea
• amenorrhea
• gynecomastia
• hyperprolactinemia
• impotence
• hyperaldosteronism
• fluid retention
• hypotension
• hypertension
• bradycardia
• nausea
• diarrhea
• urinary frequency
• incontinence
• rash
• urticaria
• visual disturbance

Pharmacology

• Half-life: 5-6h
• Metabolism: liver minimally; CYP450: unknown
• Excretion: urine 85% (20% unchanged), bile/feces 5%
• Mechanism of Action: exact mechanism of action unknown; sensitizes tissues to acetylcholine, stimulating upper GI tract motility; antagonizes central and peripheral dopamine receptors, producing antiemetic effects

References

Authors

Tasha Fernando, Ross Donaldson, Graham Grove, Claire, Neil Young, Daniel Ostermayer