Metoclopramide

Aka: Metoclopramide, Reglan

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II. Indications

  1. Gastroesophageal Reflux
  2. Gastroparesis
  3. Nausea or Vomiting
  4. Hyperemesis Gravidarum
  5. Migraine Headache

III. Contraindications

  1. Small Bowel Obstruction
  2. Bowel Perforation

IV. Mechanism

  1. Substituted benzamide that is a derivative of para-aminobenzoic acid (PABA), structurally similar to Procainamide
  2. Effects
    1. Dopamine Antagonist (D2) that has Antiemetic activity at the Medulla chemoreceptive Trigger Zone
    2. Prokinetic effects on gastrointestinal Smooth Muscle
    3. Increases gastric emptying
    4. Increases lower esophageal sphincter pressure and may reduce GERD

V. Dosing: Adults

  1. GERD: 10 mg orally four times daily taken 30 min before meals and before bedtime
  2. Gastroparesis: 10 mg PO/IV/IM four times daily taken 30 min before meals and before bedtime
  3. Nausea or Vomiting: 10 mg PO/IV/IM every 6 hours as needed
  4. Migraine Headache IV: 10 mg slow IV (see Akathisia below) or 10 mg orally with NSAID
  5. GI Procedure (UGI, Small Bowel intubation): 10 mg IV

VI. Dosing: Children (off-label)

  1. GERD: 0.4 to 0.8 mg/kg/day divided four times daily
  2. GI Procedure (UGI, Small Bowel intubation)
    1. Age <6 years old: 0.1 mg/kg IV
    2. Age 6 to 14 years old: 2.5 to 5 mg IV
    3. Age >14 years old: 10 mg IV (adult dosing)

VII. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

VIII. Adverse Effects

  1. Tardive Dyskinesia
    1. Irreversible with high dose and longterm use >3 months
    2. Avoid prolonged use >3 months
  2. Akathisia or other Extrapyramidal Side Effects
    1. Higher risk in elderly and children
    2. Common with IV administration if bolused quickly
    3. Best infused slowly over 15 minutes
    4. Treat reaction with Diphenhydramine 50 mg IV or IM
  3. Neurologic
    1. Sedation
    2. Agitation
    3. Seizures
    4. Hallucinations
  4. Gastrointestinal
    1. Constipation
    2. Diarrhea
  5. Endocrine
    1. Hyperprolactinemia
    2. Galactorrhea

IX. Drug Interactions

  1. MAO Inhibitors
    1. Significant Hypertension risk
  2. Antipsychotic Drugs
    1. Risk of Neuroleptic Malignant Syndrome
  3. CYP2D6 Inhibitors (e.g. Fluoxetine)
    1. May worsen Extrapyramidal Side Effects
  4. Metoclopramide increases absorption of other drugs
    1. Aspirin
    2. Bupropion

X. Pharmacokinetics

  1. Well absorbed
  2. Metabolized in the liver 50%
  3. Renal excretion in urine

XI. Resources

  1. Metoclopramide (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=de55c133-eb08-4a35-91a2-5dc093027397

XII. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

metoclopramide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
METOCLOPRAMIDE 10 MG TABLET Generic $0.05 each
METOCLOPRAMIDE 5 MG TABLET Generic $0.05 each
METOCLOPRAMIDE 5 MG/5 ML SOLN Generic $0.04 per ml
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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