II. Indications
III. Contraindications
- Small Bowel Obstruction
- Bowel Perforation
IV. Mechanism
- Substituted benzamide that is a derivative of para-aminobenzoic acid (PABA), structurally similar to Procainamide
- Effects
- Dopamine Antagonist (D2) that has Antiemetic activity at the Medulla chemoreceptive Trigger Zone
- Prokinetic effects on gastrointestinal Smooth Muscle
- Increases gastric emptying
- Increases lower esophageal sphincter pressure and may reduce GERD
V. Dosing: Adults
- GERD: 10 mg orally four times daily taken 30 min before meals and before bedtime
- Gastroparesis: 10 mg PO/IV/IM four times daily taken 30 min before meals and before bedtime
- Nausea or Vomiting: 10 mg PO/IV/IM every 6 hours as needed
- Migraine Headache IV: 10 mg slow IV (see Akathisia below) or 10 mg orally with NSAID
- GI Procedure (UGI, Small Bowel intubation): 10 mg IV
VI. Dosing: Children (off-label)
- GERD: 0.4 to 0.8 mg/kg/day divided four times daily
- GI Procedure (UGI, Small Bowel intubation)
- Age <6 years old: 0.1 mg/kg IV
- Age 6 to 14 years old: 2.5 to 5 mg IV
- Age >14 years old: 10 mg IV (adult dosing)
VII. Safety
- Pregnancy Category B
- Unknown safety in Lactation
VIII. Adverse Effects
-
Tardive Dyskinesia
- Irreversible with high dose and longterm use >3 months
- Avoid prolonged use >3 months
-
Akathisia or other Extrapyramidal Side Effects
- Higher risk in elderly and children
- Common with IV administration if bolused quickly
- Best infused slowly over 15 minutes
- Treat reaction with Diphenhydramine 50 mg IV or IM
- Neurologic
- Sedation
- Agitation
- Seizures
- Hallucinations
- Gastrointestinal
- Endocrine
IX. Drug Interactions
-
MAO Inhibitors
- Significant Hypertension risk
-
Antipsychotic Drugs
- Risk of Neuroleptic Malignant Syndrome
-
CYP2D6 Inhibitors (e.g. Fluoxetine)
- May worsen Extrapyramidal Side Effects
- Metoclopramide increases absorption of other drugs
X. Pharmacokinetics
- Well absorbed
- Metabolized in the liver 50%
- Renal excretion in urine
XI. Resources
- Metoclopramide (DailyMed)
XII. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 46-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
Ontology: Metoclopramide (C0025853)
| Definition (NCI) | A substituted benzamide and a derivative of para-aminobenzoic acid (PABA) that is structurally related to procainamide, with gastroprokinetic and antiemetic effects. Metoclopramide exerts its prokinetic effect by antagonizing dopamine mediated relaxation effect on gastrointestinal smooth muscle. This enhances the response of the gastrointestinal smooth muscle to cholinergic stimulation, thereby leading to an increase of gastric emptying into the intestines. Metoclopramide may also strengthen the lower esophagus sphincter, thereby preventing acid reflux. This agent antagonizes D2 dopamine receptors in chemoreceptive trigger zone (CTZ) of the medulla, thereby preventing nausea and vomiting. |
| Definition (NCI_NCI-GLOSS) | A drug that increases the motility (movements and contractions) of the stomach and upper intestine. It is used to treat certain stomach problems and nausea and vomiting caused by chemotherapy. It is a type of antiemetic and a type of motility agent. |
| Definition (MSH) | A dopamine D2 antagonist that is used as an antiemetic. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008787 |
| SnomedCT | 123235001, 317170007, 372776000, 56549003 |
| LNC | LP62994-6, LP17995-9, MTHU008221 |
| English | Metaclopramide, Benzamide, 4-amino-5-chloro-N-(2-(diethylamino)ethyl)-2-methoxy-, Metoclopramide(motility), Metoclopramide(motility) [see chapter d for preparations], metoclopramide (medication), metoclopramide, Metoclopramide [Chemical/Ingredient], metaclopramide, metaclopromide, 4-Amino-5-chloro-N-(2-(diethylamino)ethyl)-2-methoxybenzamide, Metoclopramide(motility) [see chapter d for preparations] (product), METOCLOPRAMIDE, Metoclopramide (product), Metoclopramide (substance), MCP, Metoclopramide, Metoclopramide -RETIRED-, Metoclopramide(motility) [see chapter d for preparations] (substance) |
| Swedish | Metoklopramid |
| Czech | metoklopramid |
| Finnish | Metoklopramidi |
| Russian | METOKLOPRAMID, МЕТОКЛОПРАМИД |
| Japanese | メトクロプラミド |
| Polish | Metoklopramid |
| Spanish | metoclopramida (motilidad) (ver capítulo d para preparaciones), metoclopramida (motilidad) (ver capítulo d para preparaciones) (producto), metoclopramida-RETIRADO- (concepto no activo), metoclopramida-RETIRADO-, metoclopramida (producto), metoclopramida (sustancia), metoclopramida, Metoclopramida |
| French | Métoclopramide |
| German | Metoclopramid |
| Italian | Metoclopramide |
| Portuguese | Metoclopramida |
Ontology: Reglan (C0034977)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008787 |
| English | metoclopramide (Reglan), reglan, Reglan |
