What it's for (Indications)
- Metoclopramide is indicated for the treatment of gastroesophageal reflux and acute and recurrent diabetic gastroparesis.
- It is also used for nausea and vomiting, including that associated with gastro-intestinal disorders, intolerance to cytotoxic drugs, congestive heart failure, post-operative conditions, deep X-ray and cobalt therapy.
- Additionally, it treats symptoms of upper gastrointestinal tract dysfunction such as dyspepsia, flatulence, regurgitation of bile, and heartburn.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | For gastroesophageal reflux, administer 10 to 15 mg orally, 30 minutes before each meal and at bedtime (maximum 60 mg per day) for 4 to 12 weeks. Intermittent doses up to 20 mg may be given prior to a provoking situation. For acute and recurrent diabetic gastroparesis, administer 10 mg orally, 30 minutes before each meal and at bedtime (maximum 40 mg per day) for 2 to 8 weeks. Treatment with metoclopramide should generally be avoided for longer than 12 weeks due to the increased risk of tardive dyskinesia. Dosage adjustments are recommended for elderly patients, individuals with moderate or severe hepatic or renal impairment, and cytochrome P450 2D6 (CYP2D6) poor metabolizers. |
Safety & Warnings
Common Side Effects
- Common side effects include extrapyramidal reactions (including tardive dyskinesia, other extrapyramidal effects, and tremor), neuroleptic malignant syndrome, hyperprolactinemia (which may lead to galactorrhoea, irregular periods, and gynaecomastia), drowsiness, depression, hypertension, fluid retention, diarrhoea, rash, and agitation.
- This drug may also impair the ability to drive or operate machinery.
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 metoclopramide is stopped.
- Tardive dyskinesia is a serious movement disorder that is often irreversible; the risk increases with treatment duration and total cumulative dosage.
- Discontinue metoclopramide if signs or symptoms of tardive dyskinesia appear.
- Other severe adverse reactions include other extrapyramidal effects, neuroleptic malignant syndrome, and depression.
- Patients may also experience hypertension, fluid retention, and hyperprolactinemia.
- Caution is advised in patients with renal impairment, hepatic impairment, porphyria, Parkinson’s disease, atopy, sick sinus syndrome, and other cardiac conduction disturbances.
- Dosage adjustments are required for elderly patients and those with moderate or severe hepatic or renal impairment, as well as cytochrome P450 2D6 (CYP2D6) poor metabolizers.
- The drug may cause drowsiness or impair the ability to drive or operate machinery, and alcohol consumption should be avoided.
- Regarding pregnancy, there is no evidence of risk in humans, but physician consultation is advised.
- For lactating women, caution is advised, and a doctor should be consulted.
- Treatment should generally be avoided for longer than 12 weeks due to the increased risk of tardive dyskinesia.
How it Works (Mechanism of Action)
Metoclopramide stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. The exact mechanism of action in gastroesophageal reflux and acute and recurrent diabetic gastroparesis has not been 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. It has little, if any, effect on the motility of the colon or gallbladder.
Commercial Brands (Alternatives)
No other brands found for this formula.