What it's for (Indications)
- Treatment of indigestion, flatulence, regurgitation of bile, heartburn, and other symptoms of upper GI tract.
- It is also used to treat nausea and vomiting due to various conditions such as gastro-intestinal disorders, intolerance to cytotoxic drugs, congestive heart failure, post-operative conditions, and deep X-ray or cobalt therapy.
- Specific indications include gastroesophageal reflux disease (GERD) and acute/recurrent diabetic gastroparesis (gastric stasis).
Dosage Information
| Type | Guideline |
|---|---|
| Standard | For GERD, the recommended dosage is 10 mg to 15 mg up to four times daily, taken at least 30 minutes before eating and at bedtime, for 4 to 12 weeks. For diabetic gastroparesis, the recommended dosage is 10 mg four times daily, at least 30 minutes before eating and at bedtime, for 2 to 8 weeks. Avoid treatment for longer than 12 weeks due to the increased risk of tardive dyskinesia. Take doses on an empty stomach at least 30 minutes before eating. Dosage reductions may be necessary for elderly patients, patients with moderate or severe hepatic or renal impairment, and cytochrome P450 2D6 (CYP2D6) poor metabolizers. |
Safety & Warnings
Common Side Effects
- Common side effects include drowsiness, diarrhea, rash, dizziness, tremors, and agitation.
- More serious adverse reactions include extrapyramidal reactions (movement disorders), tardive dyskinesia, neuroleptic malignant syndrome, depression, hypertension, fluid retention, and hyperprolactinemia.
- Hyperprolactinemia can lead to discharge from the nipple, irregular periods, and development of breasts in men.
- Effects on the ability to drive and operate machinery may also occur.
- Specific extrapyramidal symptoms such as tremors and agitation have been noted.
Serious Warnings
- Black Box Warning: WARNING: TARDIVE DYSKINESIA. Metoclopramide can cause tardive dyskinesia (TD), a serious movement disorder that is often irreversible. There is no known treatment for TD. The risk of developing TD increases with duration of treatment and total cumulative dosage. Discontinue metoclopramide in patients who develop signs or symptoms of TD. In some patients, symptoms may lessen or resolve after discontinuation.
- This drug should be used with caution in patients with kidney and liver impairment, porphyria, Parkinson's disease, atopy, sick sinus syndrome, and other cardiac disturbances.
- Caution is advised in lactation; consult a physician.
- There is no evidence of risk in humans during pregnancy, but medical advice should be sought.
- Dosage adjustments are recommended for elderly patients, patients with moderate or severe hepatic or renal impairment, and cytochrome P450 2D6 (CYP2D6) poor metabolizers.
- Treatment duration should generally not exceed 12 weeks due to the increased risk of tardive dyskinesia with longer-term use.
- Other serious risks include other extrapyramidal effects, neuroleptic malignant syndrome, depression, hypertension, fluid retention, and hyperprolactinemia.
How it Works (Mechanism of Action)
Metoclopramide stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. Its exact mechanism in GERD and diabetic gastroparesis is not fully established, but it appears to sensitize tissues to the action of acetylcholine. The effect on motility is not dependent on intact vagal innervation but can be abolished by anticholinergic drugs. Metoclopramide increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenal bulb, and increases peristalsis of the duodenum and jejunum, leading to accelerated gastric emptying and intestinal transit. It also increases the resting tone of the lower esophageal sphincter, with little to no effect on colon or gallbladder motility.
Commercial Brands (Alternatives)
No other brands found for this formula.