Metoclopramide
Metoclopramide (Reglan)
Metoclopramide
(meh-toe-kloh- PRAH-myd)
Pregnancy Category: B Apo-Metoclop Maxeran Maxolon Nu-Metoclopramide Octamide PFS PMS-Metoclopramide Reglan (Rx)

Classification: Gastrointestinal stimulant

Action/Kinetics: Dopamine antagonist that acts by increasing sensitivity to acetylcholine; results in increased motility of the upper GI tract and relaxation of the pyloric sphincter and duodenal bulb. Gastric emptying time and GI transit time are shortened. No effect on gastric, biliary, or pancreatic secretions. Facilitates intubation of the small bowel and speeds transit of a barium meal. Produces sedation, induces release of prolactin, increases circulating aldosterone levels (is transient), and is an antiemetic. Onset, IV: 1-3 min; IM, 10-15 min; PO, 30-60 min. Duration: 1-2 hr. t 1/2: 5-6 hr. Significant first-pass effect following PO use; unchanged drug and metabolites excreted in urine. Renal impairment decreases clearance of the drug.

Uses: PO: Acute and recurrent diabetic gastroparesis, gastroesophageal reflux. Parenteral: Facilitate small bowel intubation, stimulate gastric emptying, and increase intestinal transit of barium to aid in radiologic examination of stomach and small intestine. Prophylaxis of N&V; in cancer chemotherapy and following surgery (when nasogastric suction is not desired). Investigational: To improve lactation. N&V; due to various causes, including vomiting during pregnancy and labor, gastric ulcer, anorexia nervosa. Improve client response to ergotamine, analgesics, and sedatives when used to treat migraine (may increase absorption). Postoperative gastric bezoars. Atonic bladder. Esophageal variceal bleeding.

Contraindications: Gastrointestinal hemorrhage, obstruction, or perforation; epilepsy; clients taking drugs likely to cause extrapyramidal symptoms, such as phenothiazines. Pheochromocytoma.

Special Concerns: Use with caution during lactation and in hypertension. Extrapyramidal effects are more likely to occur in children and geriatric clients.

Side Effects: CNS: Restlessness, drowsiness, fatigue, lassitude, akathisia, anxiety, insomnia, confusion. Headaches, dizziness, extrapyramidal symptoms (especially acute dystonic reactions), Parkinson-like symptoms (including cogwheel rigidity, mask-like facies, bradykinesia, tremor), dystonia, myoclonus, depression (with suicidal ideation) tardive dyskinesia (including involuntary movements of the tongue, face, mouth, or jaw), seizures, hallucinations. GI: Nausea, bowel disturbances (usually diarrhea). CV: Hypertension (transient), hypotension, SVT, bradycardia. Hematologic: Agranulocytosis leukopenia, neutropenia. Methemoglobinemia in premature and full-term infants at doses of 1-4 mg/kg/day IM, IV, or PO for 1-3 or more days. Endocrine: Galactorrhea, amenorrhea, gynecomastia, impotence (due to hyperprolactinemia), fluid retention (due to transient elevation of aldosterone). Neuroleptic malignant syndrome: Hyperthermia, altered consciousness, autonomic dysfunction, muscle rigidity, death. Miscellaneous: Incontinence, urinary frequency, porphyria, visual disturbances, flushing of the face and upper body, hepatotoxicity.

Overdose Management: Symptoms: Agitation, irritability, hypertonia of muscles, drowsiness, disorientation, extrapyramidal symptoms. Treatment: Treat extrapyramidal effects by giving anticholinergic drugs, anti-Parkinson drugs, or antihistamines with anticholinergic effects. General supportive treatment. Reverse methemoglobinemia by giving methylene blue.

Drug Interactions: Acetaminophen / Acetaminophen absorption Anticholinergics / Metoclopramide effect Cimetidine / Cimetidine effect R/T GI tract absorption CNS depressants / Additive sedative effects Cyclosporine / Cyclosporine absorption immunosuppressive and toxic effects Digoxin / Digoxin effect R/T GI tract absorption Ethanol / Ethanol GI absorption Levodopa / Levodopa GI absorption and metoclopramide effects on gastric emptying and lower esophageal pressure MAO inhibitors / Release of catecholamines toxicity Narcotic analgesics / Metoclopramide effect Succinylcholine / Succinylcholine effect R/T plasma cholinesterase inhibition Tetracyclines / Tetracycline GI absorption

How Supplied: Concentrate: 10 mg/mL; Injection: 5 mg/mL; Tablet: 5 mg, 10 mg

Dosage
?Tablets, Syrup, Concentrate Diabetic gastroparesis.
Adults: 10 mg 30 min before meals and at bedtime for 2-8 weeks (therapy should be reinstituted if symptoms recur).
Gastroesophageal reflux.
Adults: 10-15 mg q.i.d. 30 min before meals and at bedtime. If symptoms occur only intermittently, single doses up to 20 mg prior to the provoking situation may be used.
To enhance lactation.
Adults: 30-45 mg/day.
?IM, IV Prophylaxis of vomiting due to chemotherapy.
Initial: 1-2 mg/kg IV q 2 hr for two doses, with the first dose 30 min before chemotherapy; then, 10 mg or more q 3 hr for three doses. Inject slowly IV over 15 min.
Prophylaxis of postoperative N&V.;
Adults: 10-20 mg IM near the end of surgery.
Facilitate small bowel intubation.
Adults: 10 mg given over 1-2 min; pediatric, 6-14 years: 2.5-5 mg; pediatric, less than 6 years: 0.1 mg/kg.
Radiologic examinations to increase intestinal transit time.
Adults: 10 mg as a single dose given IV over 1-2 min.