Metoclopramide

Metoclopramide (Reglan)

Category:

Gastrointestinal

Description:

Prokinetic agent; antiemetic

Indications:

Gastroesophageal reflux disease (GERD)
Diabetic gastroparesis
Facilitation of small bowel intubation
Not FDA approved: *slow bowel emptying, gastric stasis in preterm infants, drug-related postoperative nausea and vomiting

Contraindications:

Gastrointestinal hemorrhage, mechanical obstruction, or perforation of the GI tract
Pheochromocytoma
Seizure disorders

Precautions:

Pregnancy category B; may use during pregnancy as an antiemetic
Avoid use during breast feeding; potent CNS effects possible

Adverse Reactions (Side Effects):

CNS: dizziness, drowsiness, EPS (tardive dyskinesia, akathisisa, parkinson-like symptoms, dystonia), fatigue, hallucinations, seizures, sedation, restlessness, headache
CV: bradycardia, hypertension, hypotension, supraventricular arrythmias
EENT: visual disturbances
GI: bowel disturbances, diarrhea, nausea
GU: incontinence, urinary frequency
HEME: agranulocytosis, leukopenia, methemoglobinemia, neutropenia, porphyria
METAB: amenorrhea, elevated aldosterone, gtalactorrhea, gynecomastia, impotence (hyperporlactinemia)
SKIN: rash, urticaria
MISC: neuroleptic malignant syndrome

Dosage:

Administered orally (tablets,syrup), IM, and IV

Adult:
- Gastroparesis/GERD:
  - PO/IM/IV 10-15mg 30 minutes before meals and bedtime
  - PR 25mg (5 tablets compounded in polyethylene glycol) 30 minutes before meals and at bedtime.
Child:
- GERD:
  - PO/IM/IV 0.4-0.8mg/kg/day divided into 4 doses.
- Intubation small bowel:
  - IV (<age 6) 0.1mg/kg; (age 6-14) 2.5-5mg
Renal failure adjustment:
- CrCl 10-50 ml/min administer 75% of recommended dose
- CrCl <10 ml/min admister 25-50% of recommended dose

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300