Metoclopramide HCl

Antiemetic & Gastroprokinetic · Antidopaminergic

Indications

Dyspepsia, flatulence, regurgitation of bile, heartburn and other symptoms of upper Gl tract dysfunction. Nausea and vomiting due to gastro-intestinal disorders, intolerance to cytotoxic drugs, congestive heart failure, post- operative conditions, deep X-ray or cobalt therapy.

Dosage

Adults: 20 yr and over: 10 mg three times daily orally, IM or IV. Usual max 0.5 mg/kg body-wt daily. Children: Second-line option for treatment of established postoperative nausea and vomiting and prevention of delayed chemotherapy-induced nausea and vomiting: ORAL or IM injection, or IV injection over at least 3 minutes: 1-18 yr, 100-150 mcg/kg up to 3 times daily.

Administration

Injection solution may be given IM, direct IV push, short infusion (15-30 min), or continuous infusion; lower doses (=10 mg) of metoclopramide can be given IV push undiluted over 1-2 min; higher doses to be given IVPB over at least 15 min. Reconstitution: For IV use, doses <10 mg do not need dilution. For doses >10 mg, dilute in 50 mL 0.9%NS, 0.45% NS, D5W, or lactated Ringer’s solution. Compatibility: Stable in D5 1/2 NS, LR, NS, mannitol 20%. Stability: Store at 20°C-25°C (68°F-77°F). Store vials in carton until use. Do not store open single-dose vials for later use, as they contain no preservative. This product is light sensitive. It should be inspected before use and discarded if either colour or particulate is observed. Dilutions may be stored unprotected from light under normal light conditions up to 24 hours after preparation.

Adverse Effects

Extrapyramidal reactions, neuroleptic malignant syndrome. Raised serum prolactin leading to galactorrhoea, irregular periods and gynaecomastia. Drowsiness, diarrhoea, rash, dizziness, tremor, agitation.

Risk Factor (Pregnancy/Lactation)

Pregnancy: No evidence of risk in humans. Lactation: Caution advised or effect undetermined. Contraindications: Recent GI surgery, GI obstruction, perforation or haemorrhage, prolactin-dependent breast carcinoma, pheochromocytoma. Epilepsy, neonatal use. Precautions: Renal or hepatic impairment, porphyria, parkinson's disease, atopy, sick sinus syndrome, other cardiac conduction disturbances.

Interactions

Anticholinergics, phenothiazines, butyrophenones, tetrabenazine, levodopa, bromocriptine, pergolide, narcotic analgesic, aspirin, paracetamol, opioids, dopaminergics, atovaquone, CNS depressants, alcohol, SSRIs, other serotonergics, MAOIs, sympathomimetics, drugs affecting cardiac conduction, ciclosporin, suxamethonium.

Advice to Patient

Take oral forms 30 minutes before meals. Contact prescriber if there is involuntary movements of face; eyes; tongue or hands; including lip smacking, chewing, puckering of mouth, frowning, scowling, sticking out tongue, blinking, moving eyes, shaking arms and legs; unresolved diarrhoea. Restlessness, anxiety, depression, insomnia reverse when medication is discontinued. Stopping medication abruptly may cause dizziness, nervousness and headache. Do not stop abruptly, gradually lower the dose and then stop. Avoid alcohol and CNS depressants. Avoid activities that require alertness for about 2 hours after taking this medication unless full effects of medication are known.

Pharmacokinetics

Onset of action: Oral: 30-60 min. IV: 1-3 min. IM: 10-15 min. Duration: Therapeutic: 1-2 hrs. Absorption: Oral: Rapid, well absorbed. Bioavailability: Oral: 80 ± 15.5%. Half-life elimination: Normal renal function: Neonates, PMA 31-40 wks: 5.4 hrs. Infants: 4.15 hrs. Children: Approx. 4 hrs, half-life and clearance may be dose-dependant. Adults: 5-6 hrs (may be dose dependant). Time to peak, serum: Neonates, PMA 31-40 wks: 2.45 hrs. Infants: 2.2 hrs. Adults: 1-2 hrs. Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.