metoclopramide
(met oh kloe pra' mide)
Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN),
Octamide PFS, Reglan
Pregnancy Category B
Drug classes
GI stimulant
Antiemetic
Dopaminergic-blocking agent
Therapeutic actions
Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic
secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric
sphincter, which, when combined with effects on motility, accelerates gastric emptying
and intestinal transit; little effect on gallbladder or colon motility; increases lower
esophageal sphincter pressure; has sedative properties; induces release of prolactin.
Indications
• Relief of symptoms of acute and recurrent diabetic gastroparesis
• Short-term therapy (4–12 wk) for adults with symptomatic gastroesophageal
reflux who fail to respond to conventional therapy
• Parenteral: Prevention of nausea and vomiting associated with emetogenic cancer
chemotherapy
• Prophylaxis of postoperative nausea and vomiting when nasogastric suction is
undesirable
• Single-dose parenteral use: Facilitation of small-bowel intubation when tube does
not pass the pylorus with conventional maneuvers
• Single-dose parenteral use: Stimulation of gastric emptying and intestinal transit
of barium when delayed emptying interferes with radiologic exam of the stomach
or small intestine
• Unlabeled uses: Improvement of lactation (doses of 30–45 mg/day); treatment of
nausea and vomiting of a variety of etiologies: emesis during pregnancy and
labor, gastric ulcer, anorexia nervosa
Contraindications and cautions
• Contraindicated with allergy to metoclopramide; GI hemorrhage, mechanical
obstruction or perforation; pheochromocytoma (may cause hypertensive crisis);
epilepsy.
• Use cautiously with previously detected breast cancer (one third of such tumors
are prolactin dependent); lactation, pregnancy.
Available forms
Tablets—5, 10 mg; syrup—5 mg/5 mL; concentrated solution—10 mg/mL; injection—
5 mg/mL
Dosages
ADULTS
• Relief of symptoms of gastroparesis: 10 mg PO 30 min before each meal and hs
for 2–8 wk. If symptoms are severe, initiate therapy with IM or IV administration
for up to 10 days until symptoms subside.
• Symptomatic gastroesophageal reflux: 10–15 mg PO up to 4 times/day 30 min
before meals and hs. If symptoms occur only at certain times or in relation to
specific stimuli, single doses of 20 mg may be preferable; guide therapy by
endoscopic results. Do not use longer than 12 wk.
• Prevention of postoperative nausea and vomiting: 10–20 mg IM at the end of
surgery.
• Prevention of chemotherapy-induced emesis: Dilute and give by IV infusion over
not less than 15 min. Give first dose 30 min before chemotherapy; repeat q 2 hr
for 2 doses, then q 3 hr for 3 doses. The initial 2 doses should be 2 mg/kg for
highly emetogenic drugs (cisplatin, dacarbazine); 1 mg/kg may suffice for other
chemotherapeutic agents.
• Facilitation of small bowel intubation, gastric emptying: 10 mg (2 mL) by direct
IV injection over 1–2 min.
PEDIATRIC PATIENTS
• Facilitation of intubation, gastric emptying:
< 6 yr: 0.1 mg/kg by direct IV injection over 1–2 min.
6–14 yr: 2.5–5 mg by direct IV injection over 1–2 min.
Pharmacokinetics
Route Onset Peak Duration
Oral 30–60 min 60–90 min 1–2 hr
IM 10–15 min 60–90 min 1–2 hr
IV 1–3 min 60–90 min 1–2 hr
Metabolism: Hepatic; T1/2: 5–6 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
IV facts
Preparation: Dilute dose in 50 mL of a parenteral solution (dextrose 5% in water,
sodium chloride injection, dextrose 5% in 0.45% sodium chloride, Ringer's injection, or
lactated Ringer's injection). May be stored for up to 48 hr if protected from light or up to
24 hr under normal light.
Infusion: Give direct IV doses slowly (over 1–2 min); give infusions over at least 15
min.
Incompatibilities: Do not mix with solutions containing chloramphenicol, sodium
bicarbonate, cisplatin, erythromycin.
Y-site incompatibility: Do not give with furosemide.
Adverse effects
• CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal
reactions, parkinsonism-like reactions, akathisia, dystonia, myoclonus, dizziness,
anxiety
• CV: Transient hypertension
• GI: Nausea, diarrhea
Interactions
Drug-drug
• Decreased absorption of digoxin from the stomach
• Increased toxic and immunosuppressive effects of cyclosporine
Nursing considerations
Assessment
• History: Allergy to metoclopramide, GI hemorrhage, mechanical obstruction or
perforation, pheochromocytoma, epilepsy, lactation, previously detected breast
cancer
• Physical: Orientation, reflexes, affect; P, BP; bowel sounds, normal output; EEG
Interventions
• Monitor BP carefully during IV administration.
• Monitor for extrapyramidal reactions, and consult physician if they occur.
• Monitor diabetic patients, arrange for alteration in insulin dose or timing if
diabetic control is compromised by alterations in timing of food absorption.
• Keep diphenhydramine injection readily available in case extrapyramidal
reactions occur (50 mg IM).
• Have phentolamine readily available in case of hypertensive crisis (most likely to
occur with undiagnosed pheochromocytoma).
Teaching points
• Take this drug exactly as prescribed.
• Do not use alcohol, sleep remedies, sedatives; serious sedation could occur.
• These side effects may occur: Drowsiness, dizziness (do not drive or perform
other tasks that require alertness); restlessness, anxiety, depression, headache,
insomnia (reversible); nausea, diarrhea.
• Report involuntary movement of the face, eyes, or limbs, severe depression,
severe diarrhea.
Adverse effects in Italic are most common; those in Bold are life-threatening.
