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metoclopramide

A03FA01

Forms & Strengths

Tablet: 5 mg, 10 mg
Oral solution: 5 mg/5 mL, 10 mg/10 mL
Injection: 5 mg/mL

Adult Dosing

Diabetic gastroparesis: 10 mg PO/IV 30 minutes before meals and at bedtime for 2-8 weeks
GERD: 10-15 mg PO up to QID 30 minutes before meals and at bedtime
Chemotherapy-induced nausea/vomiting (CINV): 1-2 mg/kg IV every 2-4 hours

Pediatric Dosing

CINV: 1-2 mg/kg IV/PO divided every 2-6 hours
Gastroparesis (limited data): 0.1 mg/kg/dose PO/IV QID

Indications

Symptomatic diabetic gastroparesis
Prevention of chemotherapy-induced nausea and vomiting
Acute and recurrent diabetic gastric stasis
Short-term treatment of gastroesophageal reflux disease (GERD) refractory to other therapy

Mechanism of Action

Dopamine D2 receptor antagonist in the central chemoreceptor trigger zone
Serotonin 5-HT4 receptor agonist and 5-HT3 receptor antagonist in the GI tract
Enhances upper GI tract motility and accelerates gastric emptying

Contraindications

Gastrointestinal hemorrhage, mechanical obstruction, or perforation
History of tardive dyskinesia or neuroleptic malignant syndrome
Pheochromocytoma or other catecholamine-releasing paragangliomas
Concomitant use of drugs that cause extrapyramidal symptoms
Known hypersensitivity to metoclopramide

Adverse Reactions

Extrapyramidal symptoms including acute dystonia
Tardive dyskinesia (risk increases with duration and cumulative dose)
Drowsiness, fatigue, and restlessness
Hyperprolactinemia, galactorrhea, and amenorrhea
Depression and suicidal ideation

Drug Interactions

Antipsychotics: Increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome
Anticholinergics: Antagonize the gastrointestinal motility effects of metoclopramide
CNS depressants (alcohol, opioids, sedatives): Enhanced sedation
Levodopa, dopamine agonists: Mutual antagonism of therapeutic effects
CYP2D6 inhibitors: May alter systemic exposure

Curated Content: Needs Vetting Before Put to Clinical Use