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Tablet $0.01, Vial $0.70

Metoclopramide

Editor: Updated Class:

ADMINISTRATION ROUTES:

PO, IV

ALTERNATIVE NAMES:

Maxolon, Metamide

ICU INDICATIONS:

  1. Nausea
  2. Gastroparesis

PRESENTATION AND ADMINISTRATION:

PO:

Maxalon 10 mg tablets (white), Metamide 10 mg tablets (white)

IV:

10 mg/2 mL vial

Inject undiluted over 1-2 minutes

Compatible with the following IV fluids: Normal saline, Glucose and sodium chloride, 5% dextrose, Hartmanns . Do not use if the solution is cloudy or precipitate is present

Store at room temperature. Protect from light

DOSAGE:

PO:

10 mg TDS or QID

IV:

10-20 mg TDS or QID

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

GFR (ml/min) DOSE
<10 50 - 100% of normal dose
10-20 75 - 100% of normal dose
>20-50 dose as in normal renal function

Dose in renal replacement therapy

MODALITY DOSE
CAPD 50 - 100% of normal dose
HD 50 - 100% of normal dose
CVVHDF 75 - 100% of normal dose

DOSAGE IN PAEDIATRICS:

PO/IV:

0.15 - 0.30 mg/kg TDS or QID

CLINICAL PHARMACOLOGY:

The antiemetic properties of metoclopramide appear to be a result of its antagonism of central and peripheral dopamine receptors. Dopamine produces nausea and vomiting by stimulation of the medullary chemoreceptor trigger zone (CTZ). Metoclopramide blocks stimulation of the CTZ by agents like l-dopa or apomorphine which are known to increase dopamine levels or to possess dopamine-like effects. Metoclopramide stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. Its mode of action is unclear.

CONTRAINDICATIONS:

  1. Parkinsons disease
  2. Hypersensitivity to metoclopramide
  3. Mechanical bowel obstruction

WARNINGS:

Acute dystonic reactions

Extrapyramidal symptoms, manifested primarily as acute dystonic reactions, occur in approximately 1 in 500 patients treated with the usual adult dosages of 30 - 40 mg/day of metoclopramide. These are usually seen during the first 24 - 48 hours of treatment, occur more frequently in chilren and adult patients less than 30 years of age, and are even more frequent at the higher doses used in prophylaxis of vomiting due to cancer chemotherapy. These symptoms may include involuntary movements of limbs and facial grimacing, torticollis, oculogyric crises, rhythmic protrusion of tongue, bulbar type of speech, trismus, or dystonic reactions resembling tetanus. Rarely, dystonic reactions may present as stridor and dyspnoea, possibly due to laryngospasm. If these symptoms should occur, Benztropine 1-2 mg intramuscularly may be used to reverse these reactions.

Tardive Dyskinesia

Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with metoclopramide.

Neuroleptic Malignant Syndrome

There have been rare reports of an uncommon but potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) associated with metoclopramide. Symptoms consist of confusion, rigidity, high fever, seating and tachycardia. Hyperkalaemia from rhabdomyolysis may result, along with seizures. If NMS is suspected, metoclopramide should be stopped immediately and symptoms managed accordingly. This may include rapid cooling and administering medications such as diazepam or dantrolene.

PRECAUTIONS:

General:

See WARNINGS

Laboratory Tests:

No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:

None noted

IMPORTANT DRUG INTERACTIONS IN ICU:

The effects of metoclopramide on gastrointestinal motility are antagonised by anticholinergic drugs and narcotic analgesics. Additive sedative effects can occur when metoclopramide is given with alcohol, sedatives, hypnotics, narcotics, or tranquilisers

ADVERSE REACTIONS:

CNS Effects:

Restlessness, drowsiness, fatigue, insomnia, headache, confusion, dizziness, depression, acute dystonic reactions, Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies, tardive dyskinesia, NMS

Endocrine Disturbances:

Galactorrhea, amenorrhea, gynaecomastia, fluid retention

Cardiovascular:

Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure and possible AV block

Gastrointestinal:

Nausea and bowel disturbances, primarily diarrhoea. hepatotoxicity

Renal:

Urinary frequency and incontinence

Haematologic:

Neutropaenia, leukopaenia, or agranulocytosis, methaemoglobinaemia

Allergic Reactions:

A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic oedema, including glossal or laryngeal oedema