Metoclopramide

Metoclopramide Brand Names- Metozolv | Reglan

What is Metoclopramide

Metoclopramide enhances GI motility and is an effective antinauseant. It is chemically related to procainamide and the generic name is derived from the chemical name ‘methoxychloroprocainamide’.

Metoclopramide, however, does not possess local anesthetic or antiarrhythmic properties.

Metoclopramide is useful in treating adults with acute and recurrent diabetic gastroparesis. Treatment for 4 to 12 weeks of symptomatic, documented gastroesophageal reflux disease (GERD) is acceptable in qualified adults who fail to respond to conventional therapy.

Metoclopramide injection is useful in the prevention of postoperative nausea/vomiting (PONV), treatment of chemotherapy-induced nausea and vomiting, helps facilitate intubation of the small bowel, and also helps to stimulate peristalsis during a radiologic examination.

Metoclopramide can cause tardive dyskinesia (TD), a serious movement disorder that is often irreversible. The risk of developing TD increases with the duration of treatment and total cumulative dosage.

A boxed warning regarding TD exists in the metoclopramide product labels; avoid treatment for longer than 12 weeks because of the increased risk of developing TD with longer-term use.

Use of metoclopramide in pediatrics is particularly controversial due to a higher incidence of tardive dyskinesia (TD) and other extrapyramidal symptoms than when the drug is used in adults as well as the risk of methemoglobinemia in neonates.

Safety and effectiveness in pediatric patients have been established to facilitate small bowel intubation.

Safer alternatives are available for most other indications in the pediatric population, but short-term use may be clinically acceptable ‘off-label’ under select circumstances.

Indications

  1. chemotherapy-induced nausea/vomiting
  2. chemotherapy-induced nausea/vomiting prophylaxis
  3. diabetic gastroparesis
  4. feeding intolerance
  5. gastroesophageal reflux disease (GERD)
  6. gastrointestinal radiography
  7. gastroparesis
  8. intestinal intubation
  9. lactation induction
  10. migraine
  11. non-small cell lung cancer (NSCLC)
  12. post-operative nausea/vomiting (PONV)
  13. post-operative nausea/vomiting (PONV) prophylaxis
  14. pregnancy-induced nausea/vomiting
  15. singultus (hiccups)
  16. Tourette’s syndrome

For the treatment of idiopathic or postsurgical gastroparesis† or diabetic gastroparesis

Side Effects

  1. agranulocytosis
  2. akathisia
  3. amenorrhea
  4. angioedema
  5. AV block
  6. bradycardia
  7. breast enlargement
  8. bronchospasm
  9. confusion
  10. depression
  11. diarrhea
  12. dizziness
  13. drowsiness
  14. dyspnea
  15. dystonic reaction
  16. edema
  17. elevated hepatic enzymes
  18. fatigue
  19. fluid retention
  20. galactorrhea
  21. gynecomastia
  22. hallucinations
  23. headache
  24. heart failure
  25. hyperprolactinemia
  26. hypertension
  27. hypotension
  28. impotence (erectile dysfunction)
  29. infertility
  30. insomnia
  31. involuntary movements
  32. jaundice
  33. laryngeal edema
  34. laryngospasm
  35. leukopenia
  36. menstrual irregularity
  37. methemoglobinemia
  38. nausea
  39. neuroleptic malignant syndrome
  40. neutropenia
  41. porphyria
  42. pseudoparkinsonism
  43. rash
  44. restlessness
  45. seizures
  46. suicidal ideation
  47. supraventricular tachycardia (SVT)
  48. tardive dyskinesia
  49. torticollis
  50. tremor
  51. trismus
  52. urinary incontinence
  53. urinary urgency
  54. urticaria
  55. visual impairment
  56. vomiting
  57. withdrawal

Monitoring Parameters

  • serum creatinine/BUN

Contraindications

  • abrupt discontinuation
  • breast cancer
  • breast-feeding
  • cardiac disease
  • children
  • depression
  • driving or operating machinery
  • G6PD deficiency
  • geriatric
  • GI bleeding
  • GI obstruction
  • GI perforation
  • heart failure
  • hepatic disease
  • hyperprolactinemia
  • hypertension
  • infants
  • infertility
  • malignant hyperthermia
  • methemoglobin reductase deficiency
  • methemoglobinemia
  • neonates
  • paraben hypersensitivity
  • Parkinson’s disease
  • parkinsonism
  • pheochromocytoma
  • poor metabolizers
  • pregnancy
  • procainamide hypersensitivity
  • renal failure
  • renal impairment
  • seizure disorder
  • seizures
  • tardive dyskinesia

Interactions

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