Métoclopramide Uses

How do you administer this medicine?
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What is Métoclopramide?

Métoclopramide is used to treat the symptoms of a certain type of stomach problem called gastroparesis in patients with diabetes. It works by increasing the movements or contractions of the stomach and intestines. It relieves symptoms such as nausea, vomiting, heartburn, a feeling of fullness after meals, and loss of appetite. Métoclopramide is also used to treat heartburn for patients with gastroesophageal reflux disease (GERD). GERD is esophageal irritation from the backward flow of gastric acid into the esophagus.

Métoclopramide is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Métoclopramide is used in certain patients with the following medical conditions:

Métoclopramide indications

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Diabetic Gastroparesis (Diabetic Gastric Stasis)

Métoclopramide (Métoclopramide hydrochloride, USP) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis.

The Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy

Métoclopramide Injection (Métoclopramide injection) is indicated for the prophylaxis of vomiting associated with emetogenic cancer chemotherapy.

The Prevention of Postoperative Nausea and Vomiting

Métoclopramide Injection (Métoclopramide injection) is indicated for the prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable.

Small Bowel Intubation

Métoclopramide Injection (Métoclopramide injection) may be used to facilitate small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers.

Radiological Examination

Métoclopramide Injection (Métoclopramide injection) may be used to stimulate gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and/or small intestine.

How should I use Métoclopramide?

Use Métoclopramide as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Métoclopramide.

Uses of Métoclopramide in details

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Use: Labeled Indications

Injection:

Chemotherapy-induced nausea and vomiting, prophylaxis: Prophylaxis of nausea and vomiting associated with emetogenic cancer chemotherapy. Note: Injectable Métoclopramide prior to moderate- to high-emetic-risk chemotherapy is rarely indicated due to the potential for neurologic events and availability of more efficacious alternative agents.

Gastroparesis, diabetic: Relief of symptoms associated with acute and recurrent diabetic gastric stasis.

Oral:

Gastroesophageal reflux disease (GERD), refractory: Short-term (4 to 12 weeks) treatment in adults with documented symptomatic GERD who fail to respond to conventional therapy.

Note: May use Métoclopramide as an adjunctive therapy only if gastroparesis is confirmed. The American College of Gastroenterology (ACG) guidelines for the treatment of GERD recommend that diagnostic evaluation to confirm underlying gastroparesis be performed prior to considering the use of prokinetic agents (ACG [Katz 2013]). Furthermore, American Gastroenterological Association (AGA) guidelines for the treatment of GERD recommend against the use of Métoclopramide as monotherapy or adjunctive therapy in patients with GERD (AGA [Kahrilas 2008]).

Gastroparesis, diabetic: Relief of symptoms associated with acute and recurrent diabetic gastroparesis in adults.

Off Label Uses

Aspiration prophylaxis in patients undergoing anesthesia

Data from multiple studies of varying methodologies (including randomized, double-blind, placebo-controlled trials) support the use of Métoclopramide for the prevention of aspiration in patients undergoing anesthesia, for the treatment of acute tension-type headaches in the emergency department setting.

Métoclopramide description

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The prototypical analgesic used in the treatment of mild to moderate pain. It has anti-inflammatory and antipyretic properties and acts as an inhibitor of cyclooxygenase which results in the inhibition of the biosynthesis of prostaglandins. Métoclopramide also inhibits platelet aggregation and is used in the prevention of arterial and venous thrombosis. (From Martindale, The Extra Pharmacopoeia, 30th ed, p5)

Métoclopramide dosage

Usual Adult Métoclopramide Dose for Nausea/Vomiting:

Postoperative nausea and vomiting:

Parenteral: 10 to 20 mg IM at or near the end of surgery

Usual Adult Métoclopramide Dose for Gastroesophageal Reflux Disease:

Oral: 10 to 15 mg up to 4 times a day 30 minutes before meals and at bedtime, depending upon symptoms being treated and clinical response. Therapy should not exceed 12 weeks.

Usual Adult Métoclopramide Dose for Small Intestine Intubation:

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single (undiluted) dose may be administered IV slowly over 1 to 2 minutes:

Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2 minutes.

Usual Adult Métoclopramide Dose for Radiographic Exam:

Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2 minutes to facilitate gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

Usual Adult Métoclopramide Dose for Gastroparesis:

During the earliest manifestations of diabetic gastric stasis, oral administration may be initiated. If severe symptoms are present, therapy should begin with IM or IV administration for up to 10 days until symptoms subside at which time the patient can be switched to oral therapy. Since diabetic gastric stasis is often recurrent, therapy should be reinstituted at the earliest manifestation.

Parenteral: 10 mg 4 times daily, IV (slowly over a 1 to 2 minute period) or IM for up to 10 days.

Oral: 10 mg 4 times daily, 30 minutes before meals and at bedtime, for 2 to 8 weeks depending on clinical response.

Usual Adult Métoclopramide Dose for Nausea/Vomiting -- Chemotherapy Induced:

IV infusion: 1 to 2 mg/kg/dose (depending on the emetogenic potential of the agent) IV (infused over a period of not less than 15 minutes) 30 minutes before administration of chemotherapy. The dose may be repeated twice at 2 hour intervals following the initial dose. If vomiting is still not suppressed, the same dose may be repeated 3 more times at 3 hour intervals.

For doses higher than 10 mg, the injection should be diluted in 50 mL of a parenteral solution. Normal saline is the preferred diluent.

If acute dystonic reactions occur, 50 mg of diphenhydramine hydrochloride may be injected IM.

Usual Adult Métoclopramide Dose for Migraine:

Use for treatment of migraine headaches is not an FDA approved indication; however, Métoclopramide has shown efficacy in studies at a dose of 10 to 20 mg IV once (used in combination with analgesics or ergot derivatives).

Usual Pediatric Métoclopramide Dose for Gastroesophageal Reflux Disease:

Métoclopramide is not approved by the FDA for gastroesophageal reflux disease in pediatric patients; however, the following doses have been studied:

Oral, IM, IV:

Infants and Children: 0.4 to 0.8 mg/kg/day in 4 divided doses

Usual Pediatric Métoclopramide Dose for Small Intestine Intubation:

Métoclopramide IV is approved by the FDA for pediatric use to facilitate small bowel intubation by causing gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single (undiluted) dose may be administered IV slowly over 1 to 2 minutes:

Less than 6 years: 0.1 mg/kg IV as a single dose

6 to 14 years: 2.5 to 5 mg IV as a single dose

Children greater than 14 years: 10 mg as a single dose

Usual Pediatric Métoclopramide Dose for Nausea/Vomiting -- Chemotherapy Induced:

Métoclopramide is not approved by the FDA for chemotherapy induced nausea and vomiting in pediatric patients; however, the following doses have been studied:

IV:

1 to 2 mg/kg/dose IV every 30 minutes before chemotherapy and every 2 to 4 hours

Usual Pediatric Métoclopramide Dose for Nausea/Vomiting -- Postoperative:

Métoclopramide is not approved by the FDA for postoperative nausea and vomiting in pediatric patients; however, the following doses have been studied:

IV:

Children less than or equal to 14 years: 0.1 to 0.2 mg/kg/dose (maximum dose: 10 mg/dose); repeat every 6 to 8 hours as needed

Children greater than 14 years and Adults: 10 mg; repeat every 6 to 8 hours as needed

Métoclopramide interactions

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What other drugs will affect Métoclopramide?

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Anticholinergic Agents: May diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Anti-Parkinson Agents (Dopamine Agonist): Métoclopramide may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Monitor therapy

Antipsychotic Agents: Métoclopramide may enhance the adverse/toxic effect of Antipsychotic Agents. Avoid combination

Atovaquone: Métoclopramide may decrease the serum concentration of Atovaquone. Management: Consider alternatives to Métoclopramide when possible; atovaquone should only be used with Métoclopramide if no other antiemetics are available. Consider therapy modification

CycloSPORINE (Systemic): Métoclopramide may increase the absorption of CycloSPORINE (Systemic). Monitor therapy

CYP2D6 Inhibitors (Strong): May increase the serum concentration of Métoclopramide. Management: Reduce Métoclopramide dose to 5 mg 4 times daily (30 minutes before each meal and at bedtime) and limit the maximum daily dose to 20 mg if combined with strong CYP2D6 inhibitors. Consider therapy modification

Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Monitor therapy

Deutetrabenazine: May enhance the adverse/toxic effect of Métoclopramide. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased. Monitor therapy

Droperidol: May enhance the adverse/toxic effect of Métoclopramide. Avoid combination

Fosfomycin: Gastrointestinal Agents (Prokinetic) may decrease the serum concentration of Fosfomycin. Monitor therapy

Levosulpiride: Benzamide Derivatives may enhance the adverse/toxic effect of Levosulpiride. Monitor therapy

Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Monitor therapy

MetyroSINE: May enhance the adverse/toxic effect of Métoclopramide. Management: Seek alternatives to this combination when possible. Monitor patients receiving Métoclopramide with metyrosine for development of extrapyramidal symptoms. Consider therapy modification

Monoamine Oxidase Inhibitors: Métoclopramide may enhance the hypertensive effect of Monoamine Oxidase Inhibitors. Avoid combination

Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Monitor therapy

Opioid Agonists: May diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Posaconazole: Métoclopramide may decrease the serum concentration of Posaconazole. Monitor therapy

Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Monitor therapy

Promethazine: Métoclopramide may enhance the adverse/toxic effect of Promethazine. Avoid combination

Quinagolide: Métoclopramide may diminish the therapeutic effect of Quinagolide. Monitor therapy

Rivastigmine: May enhance the adverse/toxic effect of Métoclopramide. Specifically, the risk of extrapyramidal adverse reactions may be increased with this combination. Avoid combination

Selective Serotonin Reuptake Inhibitors: Métoclopramide may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Management: Seek alternatives to this combination when possible. Monitor patients receiving Métoclopramide with selective serotonin reuptake inhibitors for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome. Consider therapy modification

Serotonin/Norepinephrine Reuptake Inhibitors: Métoclopramide may enhance the adverse/toxic effect of Serotonin/Norepinephrine Reuptake Inhibitors. Management: Seek alternatives to this combination when possible. Monitor patients receiving Métoclopramide with serotonin/norepinephrine reuptake inhibitors for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome. Consider therapy modification

Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Monitor therapy

Tacrolimus (Systemic): Métoclopramide may increase the serum concentration of Tacrolimus (Systemic). Specifically, treatment of gastroparesis may increase tacrolimus concentrations. Monitor therapy

Tetrabenazine: Métoclopramide may enhance the adverse/toxic effect of Tetrabenazine. Avoid combination

Thiopental: Métoclopramide may enhance the therapeutic effect of Thiopental. Management: Consider thiopental dose reduction when used concomitantly with Métoclopramide. Monitor patient response to treatment closely if using this combination. Consider therapy modification

Tricyclic Antidepressants: Métoclopramide may enhance the adverse/toxic effect of Tricyclic Antidepressants. Management: Seek alternatives to this combination when possible. Monitor patients receiving Métoclopramide with tricyclic antidepressants for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome. Consider therapy modification

Trimetazidine: Métoclopramide may enhance the adverse/toxic effect of Trimetazidine. Specifically, the risk of extrapyramidal symptoms may be enhanced. Avoid combination

Métoclopramide side effects

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What are the possible side effects of Métoclopramide?

Applies to Métoclopramide: oral solution, oral syrup, oral tablet, oral tablet disintegrating

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by Métoclopramide. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Métoclopramide:

Rare

If any of the following symptoms of overdose occur while taking Métoclopramide, get emergency help immediately:

Symptoms of overdose:

Minor Side Effects

Some of the side effects that can occur with Métoclopramide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

Less common or rare:

Métoclopramide contraindications

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What is the most important information I should know about Métoclopramide?

Métoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation.

Métoclopramide is contraindicated in patients with pheochro-mocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phen-tolamine.

Métoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug.

Métoclopramide should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

Active ingredient matches for Métoclopramide:

Métoclopramide


Unit description / dosage (Manufacturer)Price, USD
Solution; Oral; Metoclopramide Hydrochloride 5 mg / 5 ml
Tablet; Oral; Metoclopramide Hydrochloride 10 mg
Tablet; Oral; Metoclopramide Hydrochloride 5 mg
Injectable; Injection; Metoclopramide Hydrochloride 5 mg / ml
Tablet; Oral; Metoclopramide 10 mg
Tablet, Orally Disintegrating; Oral; Metoclopramide Hydrochloride 10 mg
Tablet, Orally Disintegrating; Oral; Metoclopramide Hydrochloride 5 mg
Metoclopramide hcl powder$ 7.65
Reglan 10 mg tablet$ 1.81
Reglan 5 mg tablet$ 1.41
Metoclopramide Hydrochloride 5 mg/ml$ 1.39
Reglan 5 mg/ml vial$ 0.56
Metoclopramide HCl 5 mg tablet$ 0.43
Metoclopramide 5 mg tablet$ 0.33
Metoclopramide 10 mg tablet$ 0.28
Metoclopramide 5 mg/ml ampul$ 0.28
Metoclopramide HCl 10 mg tablet$ 0.27
Metoclopramide HCl 5 mg/5ml Solution$ 0.06
Apo-Metoclop 10 mg Tablet$ 0.06
Apo-Metoclop 5 mg Tablet$ 0.06
Nu-Metoclopramide 10 mg Tablet$ 0.06
Nu-Metoclopramide 5 mg Tablet$ 0.06
Pms-Metoclopramide 10 mg Tablet$ 0.06
Pms-Metoclopramide 5 mg Tablet$ 0.06
Pms-Metoclopramide 1 mg/ml Liquid$ 0.04
Metoclopramide / Winston 5 mg
Metoclopramide / Prince 5 mg/1 mL x 2 mL
Metoclopramide / LITA 5 mg/1 mL x 2 mL
Metoclopramide / Chin Teng 10 mg/1 g x 1 g
Metoclopramide / Tai Yu 5 mg/1 mL x 2 mL
Metoclopramide / Jen Sheng 7.67 mg
Metoclopramide / Oriental 10 mg
Metoclopramide / Update 3.84 mg
Metoclopramide / Update 1 mg/1 mL x 1 mL
Metoclopramide / Y.C. 10 mg
Metoclopramide / C.I. 5 mg
Metoclopramide / Jen Sheng 10 mg
Metoclopramide / Update 5 mg
Metoclopramide injection, solution 5 mg/mL (Cardinal Health (US))
Metoclopramide injection, solution 5 mg/2mL (General Injectables & Vaccines, Inc. (US))
Metoclopramide injection, solution 10 mg/2mL (General Injectables & Vaccines, Inc (US))
Metoclopramide solution 5 mg/5mL (Unit Dose Services (US))
Metoclopramide tablet 5 mg/1 (Qualitest Pharmaceuticals (US))
Metoclopramide tablet 10 mg/1 (Ranbaxy Pharmaceuticals Inc. (US))
Metoclopramide injection 5 mg/mL (Heritage Pharmaceuticals Inc. (US))
Metoclopramide solution 10 mg/10mL (Precision Dose Inc. (US))

List of Métoclopramide substitutes (brand and generic names):

NAUSHI DPS Drops / 1mg per ml / 30ml units (Bestochem Formulations)$ 0.27
Nausil 10 mg x 500's (Siam Bheasach)
Nausil 10 mg/2 mL x 100's (Siam Bheasach)
Nausil inj 10 mg/2 mL 100 x 1's (Siam Bheasach)
Nausil tab 10 mg 500's (Siam Bheasach)
NAUSINORM 5MG INJECTION 1 vial / 2 ML injection each (Unichem Laboratories Ltd)$ 0.11
Nilatika 10 mg x 10 x 10's (Nicholas)$ 3.72
Nofoklam 10 mg x 10 x 10's (Nufarindo)$ 3.12
Norvin Plus 500+5 Tablet (Pifer Pharmaceuticals Pvt Ltd)$ 0.01
Novomit 8 mg (Modgal Pharmaceuticals (P) Ltd.)
Novomit 8 mg x Blister pk (Modgal Pharmaceuticals (P) Ltd.)
Novomit 10+10 Tablet (Modgal Pharmaceuticals (P) Ltd.)$ 0.06
Novomit 4 mg Tablet (Modgal Pharmaceuticals (P) Ltd.)$ 0.02
NOVOMIT 10MG TABLET 1 strip / 10 tablets each (Modgal Pharmaceuticals (P) Ltd.)$ 0.53
NOVOMIT inj 2 mg x 1 mL x 2ml (Modgal Pharmaceuticals (P) Ltd.)$ 0.26
NOVOMIT tab 4 mg x 10's (Modgal Pharmaceuticals (P) Ltd.)$ 0.24
Novomit 10mg Tablet (Modgal Pharmaceuticals (P) Ltd.)$ 0.05
Tablet; Oral; Metoclopramide Hydrochloride 10 mg
Tablet; Oral; Metoclopramide Hydrochloride 5 mg
Opram 10 mg x 100's (Armoxindo Farma)$ 8.00
Opram 5 mg/5 mL x 60 mL x 1's (Armoxindo Farma)$ 1.55
Drops; Oral; Metoclopramide Hydrochloride 4 mg / ml (Solvay)
Injectable; Injection; Metoclopramide Hydrochloride 5 mg / ml (Solvay)
Tablet, Film-Coated; Oral; Metoclopramide Hydrochloride (Solvay)

References

  1. PubChem. "metoclopramide". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. DrugBank. "metoclopramide". http://www.drugbank.ca/drugs/DB01233 (accessed September 17, 2018).
  3. MeSH. "Antiemetics". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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