What is Metoclopramide?
Metoclopramide is a drug used to treat nausea and vomiting. The product ingredienst are: Metoclopramide hydrochloride (hcl) and Metoclopramide hydrochloride monohydrate.
The brand names of Metoclopramide in United States are: Reglan, Maxolon, Metozolv ODT.
Mechanism of action (MOA) Metoclopramide
D2 dopaminergic receptor antagonist of chemicoceptor stimulation and in the emetic center of the medulla involved in apomorphine – induced vomiting. 5-HT3 serotonergic receptor antagonist and 5-HT4 receptor agonist involved in chemotherapy-induced vomiting.
Therapeutic indications, uses and benefits of Metoclopramide
In adults: prevention of postoperative nausea and vomiting (NVPO), radiotherapy-induced (NVIR) or chemotherapy-induced delayed (NVIQ) and symptomatic treatment of nausea and vomiting including those induced by acute migraine.
In children and adolescents aged 1-18 years: as a second line of treatment in the prevention of delayed nausea and vomiting in chemotherapy (NVIQ) and in the treatment of postoperative nausea and vomiting (NVPO) (only via IV).
Metoclopramide posology
Adults: 10 mg up to 3 times/day.
Children: 0.1-0.15 mg/kg body weight up to 3 times/day.
Maximum duration of treatment 5 days.
Maximum dose 0.5 mg/kg/day.
Severe renal insufficiency or hepatic insufficiency decrease dose.
Mode of administration of Metoclopramide
Administer before meals.
Contraindications of Metoclopramide
- Hypersensitivity.
- Gastrointestinal bleeding, mechanical obstruction, or gastrointestinal perforation.
- History of tardive dyskinesia due to neuroleptics or metoclopramide.
- Pheochromocytoma.
- Epilepsy.
- Parkinson’s disease.
- Combination with levodopa or dopaminergic agonists.
- History of methemoglobinemia with metoclopramide or deficiency in NADH cytochrome b5 reductase.
- Children < 1 year due to increased risk of extrapyramidal reactions.
Warnings and precautions with Metoclopramide
- Renal insufficiency and hepatic insufficiency, reduce dose.
- Risk of extrapyramidal reactions, especially children and adolescents. Respect posological interval (min. 6 h) even in case of vomiting and dose rejection.
- If MNS is suspected, discontinue treatment.
- Treatment of not more than 3 months for risk of tardive dyskinesia. Administer slow IV injection min. 3 min.
- Caution in case of IV administration to patients with greater risk of cardiovascular reactions (elderly patients, cardiac alterations, uncorrected electrolyte imbalance, bradycardia or concomitance with medications that prolong the QT interval).
- Patients in underlying neurological diseases or in treatment with drugs that act in CNS.
Liver failure
Caution.
Reduce dose.
Kidney failure
Caution.
Reduce dose.
Interactions with Metoclopramide
- Mutual antagonism with: anticholinergics and morphine derivatives.
- Sedative effect enhanced by: alcohol, morphine derivatives, anxiolytics, H1 antihistamines sedatives, sedative antidepressants, barbiturates, clonidine and related.
- Reduces bioavailability of: digoxin, monitor concentration.
- Increases bioavailability of: cyclosporine, monitor concentration.
- Increases effect (with appearance of extrapyramidal alterations) of: neuroleptics, SSRIs.
- By intravenous route, it can prolong duration of neuromuscular blockade of: mivacurio, suxametonio.
Pregnancy and Metoclopramide
If necessary, assess its use in pregnancy.
Breastfeeding
This active ingredient is excreted by breast milk at a low level.
Adverse reactions in the infant cannot be excluded. Therefore, it is not recommended during lactation. Stopping this drug in breastfeeding women should be considered.
Effects on driving ability
This active ingredient can cause drowsiness, dizziness, dyskinesia and dystonia that could affect vision and also interfere with the ability to drive and use machines.
Adverse reactions and side effects of Metoclopramide
Drowsiness, diarrhea, asthenia, extrapyramidal disorders (exceeding the recommended dose), parkinsonism, akathisia, depression, hypotension, transient increase in blood pressure.
⭐⭐⭐⭐⭐ VIDEO OF METOCLOPRAMIDE/REGLAN (DRUG)
Source: The content of this active ingredient has been written taking into account the clinical and molecular information of all medicines authorised and marketed in the United States under the Unique Ingredient Identifier (UNII) by the Substance Registration System (SRS) of the Food and Drug Administration (FDA) and the United States Pharmacopeia (USP).
In order to know in detail the information authorized by the FDA for each drug, you should consult the corresponding medication guide authorized by the FDA.
Resources:
UNII: L4YEB44I46
ChemIDplus
DrugPortal
PubChem CID: 4168
NCI Thesaurus: C62046