Metoclopramide: Comprehensive Medicine Information
1. Introduction
Metoclopramide is a dopamine receptor antagonist commonly used to treat nausea, vomiting, delayed gastric emptying (gastroparesis), and gastrointestinal reflux disorders. It works by enhancing gastrointestinal motility and increasing the rate of gastric emptying while acting on the central nervous system to reduce nausea and vomiting.
2. Indications
- Nausea and vomiting (including chemotherapy-induced or postoperative nausea and vomiting)
- Delayed gastric emptying (gastroparesis)
- Gastroesophageal reflux disease (GERD) (short-term use)
- Facilitation of small bowel intubation or radiographic procedures
3. Dosage
Adults:
- Nausea and vomiting: 10 mg up to three times daily, 30 minutes before meals and at bedtime.
- Gastroparesis: 10 mg three times daily before meals.
- Procedural use: 10–20 mg as a single dose.
Children (1–18 years):
- Nausea and vomiting: 0.1–0.15 mg/kg per dose up to three times daily.
- Maximum dose: 0.5 mg/kg/day or 10 mg/day.
Elderly:
- Use the lowest effective dose due to an increased risk of side effects.
4. Administration
- Administer 30 minutes before meals for gastroparesis or GERD.
- Do not exceed a treatment duration of 5 days to minimise the risk of tardive dyskinesia.
- Injectable formulations should be administered intramuscularly or intravenously under medical supervision.
5. Forms Available
- Tablets: 5 mg, 10 mg
- Oral solution: 5 mg/5 mL
- Injectable solution: 5 mg/mL
6. Side Effects
6.1 Common Side Effects:
- Drowsiness
- Fatigue
- Restlessness
6.2 Less Common Side Effects:
- Diarrhoea
- Depression
- Dizziness
6.3 Rare but Serious Side Effects:
- Tardive dyskinesia (involuntary muscle movements, often irreversible)
- Extrapyramidal symptoms (e.g., muscle spasms, tremors)
- Neuroleptic malignant syndrome (life-threatening condition with fever, muscle rigidity, and altered mental state)
7. Warnings
- Tardive Dyskinesia Risk: Long-term or high-dose use increases the risk of irreversible tardive dyskinesia.
- CNS Effects: May cause drowsiness, confusion, or seizures, particularly in the elderly or those with underlying neurological disorders.
- Depression Risk: Use cautiously in patients with a history of depression, as it may worsen mood or cause suicidal ideation.
8. Precautions
- Use cautiously in patients with Parkinson’s disease, as metoclopramide may worsen symptoms.
- Avoid use in patients with pheochromocytoma due to the risk of hypertensive crisis.
- Adjust the dose in renal impairment to prevent drug accumulation.
9. Interactions
- CNS Depressants (e.g., sedatives, alcohol): Enhanced sedative effects.
- Antipsychotics: Increased risk of extrapyramidal symptoms.
- Digoxin: Reduced absorption due to accelerated gastric emptying.
- Levodopa: Opposing effects; avoid concurrent use.
10. Monitoring Parameters
- Monitor for extrapyramidal symptoms, particularly in children and the elderly.
- Watch for signs of tardive dyskinesia with long-term use.
- Assess renal function in patients with chronic kidney disease.
11. Use in Children
- Approved for short-term use in children for nausea and vomiting under close medical supervision.
- Avoid long-term use due to an increased risk of neurological side effects, including extrapyramidal symptoms.
12. Use in Pregnancy
- Generally considered safe during pregnancy (Category A in Australia, Category B in the US). Often used for hyperemesis gravidarum under medical supervision.
13. Use in Elderly
- Increased risk of drowsiness, confusion, and extrapyramidal symptoms. Start with the lowest effective dose and monitor closely.
14. Use in Kidney Disease
- Dose adjustment is necessary in moderate to severe renal impairment (creatinine clearance <40 mL/min). Reduce frequency or dose.
15. Use in Liver Disease
- Use with caution in severe liver disease due to potential accumulation and an increased risk of side effects.
16. Patient Counselling Points
- Take the medication 30 minutes before meals for optimal effect.
- Avoid alcohol and sedatives while taking metoclopramide.
- Do not exceed the prescribed duration (usually 5 days) to reduce the risk of neurological side effects.
- Report any unusual movements, stiffness, or difficulty speaking immediately.
- Be aware of drowsiness and avoid driving or operating machinery if affected.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Reglan | ANI Pharmaceuticals | 10 mg Tablet | $20 (30 tablets) |
Metozolv ODT | Salix Pharmaceuticals | 10 mg Orally Disintegrating Tablet | $40 (30 tablets) |
Generic Metoclopramide | Various | 10 mg Injection | $15 (5 ampoules) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Metoclopramide?
Metoclopramide is a medication used to treat nausea, vomiting, and delayed gastric emptying.
2. How does Metoclopramide work?
It works by blocking dopamine receptors in the brain and gut, improving gastrointestinal motility and reducing nausea.
3. What is the recommended dosage of Metoclopramide?
The typical dose for adults is 10 mg up to three times daily, 30 minutes before meals.
4. Can Metoclopramide be used during pregnancy?
Yes, it is often used during pregnancy for severe nausea and vomiting (hyperemesis gravidarum).
5. Is Metoclopramide safe for children?
Yes, it can be used for nausea and vomiting in children, but only under medical supervision.
6. What are the common side effects of Metoclopramide?
Common side effects include drowsiness, fatigue, and restlessness.
7. Are there serious risks with Metoclopramide?
Yes, prolonged use increases the risk of tardive dyskinesia and other neurological side effects.
8. How long can I take Metoclopramide?
Treatment should not exceed 5 days to reduce the risk of serious side effects.
9. What should I do if I miss a dose?
Take the missed dose as soon as you remember, unless it is close to the next dose.
10. Can Metoclopramide interact with other medications?
Yes, it interacts with CNS depressants, digoxin, antipsychotics, and levodopa.
11. Is Metoclopramide addictive?
No, but it has potential for serious side effects with misuse.
12. Can Metoclopramide worsen Parkinson’s disease?
Yes, it may worsen symptoms of Parkinson’s disease.
13. How should Metoclopramide be stored?
Store at room temperature, away from moisture and light.
14. Do I need a prescription for Metoclopramide?
Yes, Metoclopramide is a prescription-only medication.
15. Can I take Metoclopramide with alcohol?
No, alcohol can increase drowsiness and other CNS effects.