Metoclopramide

A to Z Drug Facts

Actions Stimulates upper GI tract motility, resulting in accelerated gastric emptying and intestinal transit and increased resting tone of lower esophageal sphincter. Exerts antiemetic properties through antagonism of central and peripheral dopamine receptors.

 Indications

PO

Relief of symptoms associated with acute and recurrent diabetic gastroparesis; short-term therapy of symptomatic, documented gastroesophageal reflux disease in adults 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; facilitation of small bowel intubation when tube does not pass pylorus with conventional maneuvers.

Treatment of hiccoughs, migraines, postoperative gastric bezoars, improvement in lactation, radiation-induced emesis.

 Contraindications Patients in whom increase in GI motility could be harmful (eg, in presence of GI hemorrhage, mechanical obstruction, perforation); pheochromocytoma; epilepsy; patients receiving drugs likely to cause extrapyramidal reactions.

 Route/Dosage

Nausea and Vomiting Caused by Highly Emetogenic Chemotherapy

ADULTS: IV 2 mg/kg by infusion for 2 doses; give the first dose 30 min before chemotherapy, the second dose 2 hr later. If vomiting persists, 3 additional doses of 2 mg/kg may be given q 3 hr. If vomiting is controlled, 3 additional doses of 1 mg/kg may be given q 3 hr.

PO 2 mg/kg 1 hr before chemotherapy, followed by 3 more doses at 2-hr intervals. If vomiting persists, 2 additional doses may be given q 3 hr (total daily dose of 12 mg/kg).

Nausea and Vomiting with Less Emetogenic Chemotherapy

ADULTS: IV 1 mg/kg by infusion 30 min before chemotherapy, repeated q 2 hr for 3 doses.

Prevention of Delayed Nausea and Vomiting Caused by Chemotherapy

ADULTS: PO 0.5 mg/kg qid for 4 days beginning 16 to 24 hr after chemotherapy given, in combination with dexamethasone. May be given IV in patients unable to take PO.

Adjustment in Renal Insufficiency

Reduce initial dose 50% in patients with Ccr < 40 mL/min. Titrate subsequent doses based on patient response.

Interactions

Acetaminopohen, cyclosporine, ethanol, levodopa, tetracycline

Metoclopramide may increase oral bioavailability or absorption of these drugs.

Anticholinergic, opioid analgesics, levodopa

May decrease effect of metoclopramide on gastric emptying.

Cefprozil, cimetidine, digoxin

Metoclopramide may decrease oral absorption of these drugs.

CNS depressants (eg, alcohol, anesthetics, barbiturates, opiates)

May potentiate CNS depressant effects of metoclopramide.

Succinylcholine and possibly mivacurium

By inhibiting plasma cholinesterase metoclopramide may prolong neuromuscular blocking effects such as respiratory depression and paralysis.

INCOMPAT Cephalothin, chloramphenicol, sodium bicarbonate.

Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Dizziness; drowsiness; depression; hallucinations; extrapyridal symptoms which respond rapidly to treatment with anticholinergic agents (eg, diphenhydramine IV); exacerbation of Parkinson disease; tardive dyskinesia; akathisia. DERMATOLOGIC: Transient flushing of face or upper body with high IV doses. ENDOCRINE: Hyperprolactinemia; galactorrhea; gynecomastia (in men). GI: Diarrhea. GU: Urinary frequency; incontinence; amenorrhea. HYPERSENSITIVITY: Injectable solutions may contain sodium metabisulfite, a sulfite. Sensitive individuals may experience allergic reactions (eg, anaphylaxis, bronchospasm, angioedema).

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Some efficacy has been demonstrated. However, methemoglobinemia has occurred in newborns. Anastomosis or closure of gut: Drug could theoretically put increased pressure on suture lines after gut anastomosis or closure. Carcinogenesis: Because the drug elevates serum prolactin concentration, use caution if administration of metoclopramide is considered in patient with previously detected breast cancer. Depression: Depression has occurred with or without history of depression. Symptoms have ranged from mild to severe and have included suicidal ideation and suicide. Extrapyramidal symptoms: Manifest primarily as acute dystonic reactions, occurring usually during first 24 to 48 hr and more frequently in children and young adults or at higher doses. Hypertension: Use with caution. Parkinson-like symptoms: Occur more commonly within first 6 mo of treatment but also can occur after longer periods. Symptoms generally subside within 2 to 3 mo after drug discontinuation. Give drug cautiously, if at all, to patients with preexisting Parkinson disease. Tardive dyskinesia: Tardive dyskinesia may develop, especially in the elderly. Risk of development and likelihood of irreversibility increases with treatment duration and total cumulative dose.

 Administration/Storage

• Administer oral form 30 min before meals and at bedtime.
• For IV admixture, when diluted in parenteral solution, administer slowly over ³ 15 min.
• For IM and IV bolus, inject slowly over 1 to 2 min.
• For parenteral doses > 10 mg, dilute in 50 mL Sodium Chloride Injection.
• Store all dosage forms at room temperature in tight, light-resistant containers.
• Administer PO, IM injection, direct IV injection, or intermittent IV infusion (doses > 10 mg).
• Dilute the oral concentration (10 mg/mL) with liquid (eg, water, juice, soda) or mix with semisolid food (eg, applesauce, pudding) immediately before giving.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of epilepsy, seizures, hypertension, Parkinson disease, GI bleeding, or bowel obstruction.
• Take safety precautions because of high risk for falls caused by drowsiness and decreased dexterity.
• Notify health care provider of acute CNS reactions, arrhythmias, hypotension, hypertension, and suicidal ideations.

 Patient/Family Education

• Instruct patient to take medication 30 min before meals.
• Instruct patient to report the following symptoms to the health care provider: involuntary movement of eyes, face, or limbs.
• Caution patient to avoid intake of alcoholic beverages.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts