What is Metocal 10?
Metocal 10 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. Metocal 10 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.
Metocal 10 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, Metocal 10 is used in certain patients with the following medical conditions:
- Failure of the stomach to empty its contents.
- Nausea and vomiting caused by other medicines.
- Persistent hiccups.
- Prevention of aspirating fluid into the lungs during surgery.
- Vascular headaches.
Metocal 10 indications
The use of Metocal 10™ (Metocal 10 orally disintegrating tablets) is recommended for adults only. Therapy should not exceed 12 weeks in duration.
Symptomatic Gastroesophageal Reflux
Metocal 10™ (Metocal 10 orally disintegrating tablets) is indicated as short-term (4 to 12 weeks) therapy for adults with symptomatic, documented gastroesophageal reflux who fail to respond to conventional therapy.
The principal effect of Metocal 10 is on symptoms of postprandial and daytime heartburn with less observed effect on nocturnal symptoms. If symptoms are confined to particular situations, such as following the evening meal, use of Metocal 10 as single doses prior to the provocative situation should be considered, rather than using the drug throughout the day. Healing of esophageal ulcers and erosions has been endoscopically demonstrated at the end of a 12-week trial using doses of 15 mg four times daily. As there is no documented correlation between symptoms and healing of esophageal lesions, patients with documented lesions should be monitored endoscopically.
Diabetic Gastroparesis (Diabetic Gastric Stasis)
Metocal 10™ (Metocal 10 orally disintegrating tablets) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis. The usual manifestations of delayed gastric emptying (e.g., nausea, vomiting, heartburn, persistent fullness after meals, and anorexia) appear to respond to Metocal 10 within different time intervals.
Important Limitations
Metocal 10™ (Metocal 10 orally disintegrating tablets) is indicated for adults only. Therapy should not exceed 12 weeks in duration. The safety and effectiveness in pediatric patients have not been established.
How should I use Metocal 10?
Use Metocal 10 orally disintegrating tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Metocal 10 orally disintegrating tablets comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Metocal 10 orally disintegrating tablets refilled.
- Take Metocal 10 orally disintegrating tablets by mouth 30 minutes before meals and at bedtime without food or water unless directed otherwise by your doctor.
- Do not remove the tablet from the blister pack until you are ready to take Metocal 10 orally disintegrating tablets. Make sure that your hands are dry when you open the blister pack. If the tablet breaks or crumbles while handling, discard and remove a new tablet. Place the tablet on your tongue. The tablet dissolves quickly and can be swallowed with saliva. Take the tablet immediately after opening the blister pack. Do not store the removed tablet for future use.
- It may take several days to weeks for Metocal 10 orally disintegrating tablets to work. Do not stop taking Metocal 10 orally disintegrating tablets without checking with your doctor.
- If you miss a dose of Metocal 10 orally disintegrating tablets, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Metocal 10 orally disintegrating tablets.
Uses of Metocal 10 in details
Use: Labeled Indications
Injection:
Chemotherapy-induced nausea and vomiting, prophylaxis: Prophylaxis of nausea and vomiting associated with emetogenic cancer chemotherapy. Note: Injectable Metocal 10 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 Metocal 10 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 Metocal 10 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 Metocal 10 for the prevention of aspiration in patients undergoing anesthesia, for the treatment of acute tension-type headaches in the emergency department setting.
Metocal 10 description
Each ampoule of injection contains anhydrous Metocal 10 (as Metocal 10) 10 mg in 2 mL and sodium chloride in water for injections. When necessary, pH is adjusted with sodium hydroxide and/or hydrochloric acid.
Metocal 10 is 4-amino-5-chloro-N-(2-diethylaminoethyl)-2-methoxybenzamide HCl monohydrate. It has a molecular weight of 354.3 and its molecular formula is C14H22ClN3O2·HCl·H2O.
Metocal 10 hydrochloride occurs as a white or almost white, crystalline powder or crystals, very soluble in water, freely soluble in alcohol, sparingly soluble in methylene chloride, practically insoluble in ether.
Metocal 10 dosage
Therapy with Metocal 10™ (Metocal 10 orally disintegrating tablets) should not exceed 12 weeks in duration.
Instructions for Use/Handling Metocal 10™ (Metocal 10 orally disintegrating tablets)
Just prior to administration, remove the Metocal 10™ (Metocal 10 orally disintegrating tablets) orally disintegrating tablet from the packaging with dry hands. The tablet should be removed from the package and immediately placed on the tongue, to disintegrate and be swallowed with the saliva. The tablet typically disintegrates in about one and one-half minutes. Administration with liquid is not necessary.
Symptomatic Gastroesophageal Reflux Disease
For the relief of symptomatic, documented gastroesophageal reflux disease (GERD), therapy should not exceed 12 weeks.
Administer from 10 mg to 15 mg of Metocal 10™ (Metocal 10 orally disintegrating tablets) orally up to four times daily, 30 minutes before each meal and at bedtime, depending upon symptoms being treated and clinical response. If symptoms occur only intermittently or at specific times of the day, use of Metocal 10 in single doses up to 20 mg prior to the provoking situation may be preferred rather than continuous treatment. Occasionally, patients (such as elderly patients) who are more sensitive to the therapeutic or adverse effects of Metocal 10 will require only 5 mg per dose.
Experience with esophageal erosions and ulcerations is limited, but healing has thus far been documented in one controlled trial using four times daily therapy at 15 mg/dose, and this regimen should be used when lesions are present, so long as it is tolerated. Because of the poor correlation between symptoms and endoscopic appearance of the esophagus, therapy directed at esophageal lesions is best guided by endoscopic evaluation.
Prolonged treatment ( > 12 weeks) with Metocal 10 should be avoided in all but rare cases where therapeutic benefit is thought to counterbalance the risks to the patient of developing tardive dyskinesia..
Diabetic Gastroparesis (Diabetic Gastric Stasis)
For the relief of symptoms associated with diabetic gastroparesis (diabetic gastric stasis), therapy of two to eight weeks is recommended. Therapy should not exceed 12 weeks in duration.
Administer 10 mg of Metocal 10™ (Metocal 10 orally disintegrating tablets) 30 minutes before each meal and at bedtime for two to eight weeks, depending upon response and the likelihood of continued well-being upon drug discontinuation.
The initial route of administration should be determined by the severity of the presenting symptoms. If only the earliest manifestations of diabetic gastric stasis are present, oral administration of Metocal 10™ (Metocal 10 orally disintegrating tablets) may be initiated. However, if severe symptoms are present, therapy should begin with Metocal 10 injection (consult labeling of the injection prior to initiating parenteral administration).
Administration of Metocal 10 injection up to 10 days may be required before symptoms subside, at which time oral administration may be instituted. Since diabetic gastric stasis is frequently recurrent, Metocal 10™ (Metocal 10 orally disintegrating tablets) therapy should be reinstituted at the earliest manifestation.
Patients with Renal Impairment
Since Metocal 10 is excreted principally through the kidneys, in those patients whose creatinine clearance is below 40 mL/min, therapy should be initiated at approximately one-half the recommended dosage. Depending upon clinical efficacy and safety considerations, the dosage may be increased or decreased as appropriate.
How supplied
Dosage Forms And Strengths
Metocal 10™ (Metocal 10) orally disintegrating tablets contains either 5 mg or 10 mg of Metocal 10 base (as monohydrochloride monohydrate). The tablets are white, round, flat-faced, and orange flavored.
Metocal 10™ (Metocal 10) orally disintegrating tablets 5 mg base (as the monohydrochloride monohydrate) are white, round, flat-faced, orange-flavored and engraved "AP" on one side and "152" on the other side. They are supplied as follows:
Bottles of 100..................NDC 68220-152-10
Metocal 10™ (Metocal 10) orally disintegrating tablets 10 mg base (as the monohydrochloride monohydrate) are white, round, flat-faced, orange-flavored and engraved "AP"on one side and "153" on the other side. They are supplied as follows:
Bottles of 100..................NDC 68220-153-10
Storage and Handling
Store at 20° to 25°C (68° to 77°F); excursions permitted between 15° to 30°C (59° to 86°F). Protect from moisture.
Dispense in a tight, light-resistant container as defined in the USP/NF.
Manufactured for: Alaven Pharmaceuticals LLC., Marietta, GA 30062. www.alavenpharm.com. For Medical Inquiries, call toll-free 1-888-317-0001. Manufactured by: CIMA® LABS INC.
Metocal 10 interactions
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What other drugs will affect Metocal 10?
Anticholinergic drugs and narcotic analgesics may antagonise the effects of Metocal 10 on gastrointestinal motility.
Alcohol, sedatives, hypnotics, narcotics and tranquilisers have additive sedative effects when administered in conjunction with Metocal 10.
Metocal 10 may cause extrapyramidal symptoms in some patients. Therefore, when Metocal 10 is used concomitantly with other drugs that are likely to cause extrapyramidal reactions [eg, neuroleptics (eg, phenothiazines)], caution should be exercised.
Due to its effects on gastric motility, Metocal 10 may affect the rate of absorption of drugs from the gastrointestinal tract. Absorption of drugs eg, paracetamol, aspirin in patients with migraine, cyclosporin, diazepam, dopamine, levodopa and morphine-controlled release tablets which are mainly absorbed from the small bowel, may be accelerated. Absorption of drugs eg, digoxin, bromocriptine, cimetidine, penicillin and quinidine which are mainly absorbed from the stomach, may be decreased.
The decrease in gastric emptying time caused by Metocal 10 may increase the bioavailability of cyclosporin. Monitoring of cyclosporin concentrations may be necessary.
When Metocal 10 is given concurrently with suxamethonium, the recovery time is prolonged.
Since Metocal 10 influences the delivery of food to the intestine and thus, the rate of its absorption, the administration of Metocal 10 may result in poor diabetic control in some patients. Therefore, adjustment in or timing of insulin dosage may be necessary in insulin-controlled diabetics.
The finding that Metocal 10 releases catecholamines in patients with essential hypertension suggests that it should be used cautiously, if at all, in patients receiving monoamine oxidase inhibitors.
Effect on Laboratory Tests: Metocal 10 may blunt the response to the gonadorelin diagnostic test, by increasing serum prolactin levels. It may alter hepatic function test results.
Metocal 10 side effects
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What are the possible side effects of Metocal 10?
Neurological: Adverse reactions to Metocal 10 that are most frequently seen are restlessness, drowsiness, fatigue and lassitude, which occur in approximately 10% of patients. Insomnia, headache, dizziness have been reported less frequently. Acute depression has been reported rarely (<1 in 1000 cases). Symptoms of Metocal 10 induced depression have ranged from mild to severe and have included suicidal ideation and suicide. Anxiety or agitation may occur, especially after rapid injection. Delirium, severe dysphoria, obsessive rumination and mania have been reported occasionally.
Parkinsonian symptoms including tremor, rigidity, bradykinesia and akinesia, occur rarely in patients receiving Metocal 10 but may be associated with usual or excessive doses or with decreased renal function.
Various extrapyramidal reactions to Metocal 10, usually of the dystonic type, have been reported. Acute dystonic reactions occur in approximately 0.2% of patients treated with Metocal 10 30-40 mg/day. In cancer chemotherapy, patients receiving 1-2 mg/kg/dose, the incidence is 2% in patients over the ages of 30-35, and 25% or higher in children and young adults who have not had prophylactic administration of diphenhydramine. Reactions include spasm of the facial muscles, trismus, rhythmic protrusion of the tongue, a bulbar type of speech, spasm of the extraocular muscles including oculogyric crisis, unnatural positioning of the head and shoulders and opisthotonos. There may be a generalised increase in muscle tone. The majority of reactions occur within 36 hrs of starting treatment and the effects usually disappear within 24 hrs of withdrawal of the drug. However, close observation is required, and in cases of more severe reactions, an antiparkinson drug eg, benztropine or an anticholinergic antihistamine eg, diphenhydramine should be given.
A fatal acute dystonic reaction has been reported in a patient who received hexamethylmelamine, cisplatin and Metocal 10 high dose. Dystonic reactions may present rarely as upper airway obstruction with stridor and dyspnoea, possibly secondary to laryngospasm or supraglottic dystonia. A fatal cardiorespiratory arrest occurred in at least 1 patient with an acute dystonic reaction.
Tardive dyskinesia, which may be persistent, has been reported particularly in elderly patients (particularly women) following long-term therapy with Metocal 10. Tardive dyskinesia is most frequently characterised by involuntary movements of the tongue, face, mouth or jaw, and sometimes by involuntary movements of the trunk and/or extremities. The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase with increasing duration of therapy and total cumulative dose. Although tardive dyskinesia can occur after relatively brief therapy with the drug at low doses, it appears to be more readily reversible under such circumstances.
Neuroleptic Malignant Syndrome (NMS): It has been reported very rarely (<2 in 10,000). NMS is potentially fatal and comprises hyperpyrexia, altered consciousness, muscle rigidity, autonomic instability and elevated levels of CPK, and must be treated urgently (recognised treatments include dantrolene and bromocriptine).
Metocal 10 should be stopped immediately if NMS occurs.
Gastrointestinal: Nausea or bowel disturbances have been reported.
Cardiovascular: A single case of supraventricular tachycardia following IM administration has been reported. Cardiac conduction abnormalities (eg, bradycardia and heart block) have occurred very rarely (<1 in 10,000) in association with IV Metocal 10. Atrial fibrillation, oedema, ventricular fibrillation, ventricular tachycardia, palpitations and tachycardia have also been associated with the use of Metocal 10. In 1 study in hypertensive patients, IV administered Metocal 10 was shown to release catecholamines; hence, caution should be exercised when Metocal 10 is used in patients with hypertension.
Endocrine: Raised serum prolactin levels have been observed during Metocal 10 therapy; this effect is similar to that noted with many other compounds. Galactorrhoea and breast enlargement have also been observed during Metocal 10 therapy.
Hypersensitivity: There have been isolated reports of hypersensitivity reactions (eg, urticaria, maculopapular rash) in patients receiving the drug.
Respiratory: Respiratory failure, secondary to dystonic reaction, acute asthmatic symptoms of wheezing and dyspnoea may occur.
Genitourinary: Urinary incontinence, sexual dysfunction, priapism and muscle spasm may also occur.
Other Effects: There have been isolated reports of blood disorders. Methaemoglobinaemia, particularly following overdose in neonates, has also occurred in patients receiving the drug. Agranulocytosis and hyperthermia have also been observed.
Metocal 10 contraindications
See also:
What is the most important information I should know about Metocal 10?
NEVER TAKE Metocal 10 IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of Metocal 10 can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take Metocal 10, the more likely you are to develop a serious movement disorder. The risk of this side effect is higher in women, diabetics, and older adults.
You should not take this medication if you are allergic to Metocal 10, or if you have bleeding or blockage in your stomach or intestines, epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma).
Before you take Metocal 10, tell your doctor if you have kidney or liver disease, congestive heart failure, high blood pressure, diabetes, Parkinson's disease, or a history of depression.
Do not drink alcohol. It can increase some of the side effects of Metocal 10.
There are many other medicines that can interact with Metocal 10. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.
Stop using Metocal 10 and call your doctor at once if you have tremors or uncontrolled muscle movements, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing, depressed mood, thoughts of suicide or hurting yourself, hallucinations, anxiety, agitation, seizure, or jaundice (yellowing of your skin or eyes).
Active ingredient matches for Metocal 10:
List of Metocal 10 substitutes (brand and generic names) | Sort by popularity |
| Unit description / dosage (Manufacturer) | Price, USD |
| Metoca (Pakistan) | |
| Metoceolat (Austria) | |
| Metoclamid (Germany) | |
| Metoclan (Portugal) | |
| Metoclol | |
| Metoclon (Pakistan) | |
| Metoclop (India) | |
| METOCLOP Injection / 5mg per ml / 2ml units (Ind-Swift) | $ 0.07 |
| Metoclop 5mg/mL AMP / 2ml (Ind-Swift) | $ 0.07 |
| Metoclop 5mg/mL VIAL / 10ml (Ind-Swift) | $ 0.22 |
| Metoclop 5mg/mL VIAL / 30ml (Ind-Swift) | $ 0.36 |
| 5 mg x 1 mL x 2ml (Ind-Swift) | $ 0.07 |
| 5 mg x 1 mL x 10ml (Ind-Swift) | $ 0.22 |
| 5 mg x 1 mL x 30ml (Ind-Swift) | $ 0.36 |
| METOCLOP inj 5 mg x 1 mL x 2ml (Ind-Swift) | $ 0.07 |
| METOCLOP inj 5 mg x 1 mL x 10ml (Ind-Swift) | $ 0.22 |
| METOCLOP inj 5 mg x 1 mL x 30ml (Ind-Swift) | $ 0.36 |
| Metoclop NA Tablet (Ind-Swift) | $ 0.01 |
| METOCLOP (IND-SWIFT) | |
| METOCLOP 5MG INJECTION 1 vial / 30 ML injection each (Ind Swift Laboratories Ltd) | $ 0.10 |
| METOCLOP 5MG INJECTION 1 vial / 10 ML injection each (Ind Swift Laboratories Ltd) | $ 0.12 |
| METOCLOP 5MG INJECTION 1 vial / 2 ML injection each (Ind Swift Laboratories Ltd) | $ 0.07 |
| METOCLOP TABLET 1 strip / 10 tablets each (Ind Swift Laboratories Ltd) | $ 0.10 |
| Metoclopramid (Georgia, Romania) | |
| Injectable; Injection; Metoclopramide Hydrochloride 5 mg / ml (Arena group) | |
| Tablet; Oral; Metoclopramide Hydrochloride 10 mg (Arena group) | |
| Drops; Oral; Metoclopramide (Arena group) | |
| Tablet; Oral; Metoclopramide 10 mg (Arena group) | |
| Metoclopramid Actavis (Hong Kong) | |
| Metoclopramid Arena (Romania) | |
| Metoclopramid AWD (Germany) | |
| Metoclopramid Biofarm (Romania) | |
| Metoclopramid Laropharm (Romania) | |
| Metoclopramid Polpharma (Latvia, Lithuania) | |
| Metoclopramid Rup Borisov (Georgia) | |
| Metoclopramid S.C. Slavia (Georgia) | |
| Metoclopramid Slavia (Romania) | |
| Metoclopramid Terapia (Romania) | |
| Metoclopramid-Akri (Russian Federation) | |
| Metoclopramida (Brazil, Colombia, Ecuador, Peru, Venezuela) | |
| Injectable; Injection; Metoclopramide 5 mg / ml | |
| Tablet; Oral; Metoclopramide 10 mg | |
| Metoclopramida 10mg Biosano (Paraguay) | |
| Metoclopramida 10mg/2ml Fada (Paraguay) | |
| Metoclopramida 10mg/2ml Larjan (Paraguay) | |
| Metoclopramida Abex (Spain) | |
See 1330 substitutes for Metocal 10 | |
References
- PubChem. "metoclopramide". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "metoclopramide". http://www.drugbank.ca/drugs/DB01233 (accessed September 17, 2018).
- MeSH. "Antiemetics". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Metocal 10 are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Metocal 10. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
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Information checked by Dr. Sachin Kumar, MD Pharmacology
