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Metoclopramide Dosage

Applies to the following strength(s): 10 mg ; 5 mg ; 5 mg/5 mL ; 5 mg/mL ; 10 mg/mL

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Nausea/Vomiting - Chemotherapy Induced

EMETOGENIC CANCER CHEMOTHERAPY:
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.

Comments:
-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 may be injected IM.

Uses:
-For the prophylaxis of vomiting associated with emetogenic cancer chemotherapy

POSTOPERATIVE NAUSEA AND VOMITING:
IM: 10 to 20 mg IM at or near the end of surgery

Uses:
-For prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable

POSTOPERATIVE NAUSEA AND VOMITING:
IM: 10 to 20 mg IM at or near the end of surgery

Uses:
-For prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable

Usual Adult Dose for Nausea/Vomiting - Postoperative

EMETOGENIC CANCER CHEMOTHERAPY:
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.

Comments:
-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 may be injected IM.

Uses:
-For the prophylaxis of vomiting associated with emetogenic cancer chemotherapy

POSTOPERATIVE NAUSEA AND VOMITING:
IM: 10 to 20 mg IM at or near the end of surgery

Uses:
-For prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable

POSTOPERATIVE NAUSEA AND VOMITING:
IM: 10 to 20 mg IM at or near the end of surgery

Uses:
-For prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable

Usual Adult Dose for Small Intestine Intubation

TO FACILITATE SMALL BOWEL INTUBATION:
IV:
-If the tube has not passed the pylorus with conventional maneuvers in 10 minutes, a single dose (undiluted) may be administered slowly IV over a 1 to 2 minute period.
-The recommended single dose is: Pediatric patients above 14 years of age and adults: 10 mg IV metoclopramide base

Usual Adult Dose for Radiographic Exam

TO AID IN RADIOLOGICAL EXAMINATIONS:
-In patients where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine, a single IV dose may be administered slowly over a 1 to 2 minute period.
-The recommended single dose is: Adults and pediatric patients greater than or equal to 14 years: 10 mg IV metoclopramide base 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 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 IV (slowly over a 1 to 2 minute period) or IM for up to 10 days
-Oral: 10 mg orally 30 minutes before each meal and at bedtime for 2 to 8 weeks, depending upon response and the likelihood of continued well-being upon drug discontinuation

Use: For the relief of symptoms associated with acute and recurrent diabetic gastric stasis.

Usual Adult Dose for Gastroesophageal Reflux Disease

-ORAL: 10 to 15 mg orally up to 4 times a day 30 minutes before meals and at bedtime, depending upon symptoms being treated and clinical response
-Some patients who are more sensitive to adverse effects can be maintained on 5 mg orally per dose.
-When lesions are present: 15 mg orally 4 times a day, if tolerated
-Maximum duration of therapy: 12 weeks

Comments:
-Because of the poor correlation between symptoms and endoscopic appearance of the esophagus, therapy directed at esophageal lesions is best guided by endoscopic evaluation.

Usual Pediatric Dose for Small Intestine Intubation

TO FACILITATE SMALL BOWEL INTUBATION:
IV:
-If the tube has not passed the pylorus with conventional maneuvers in 10 minutes, a single dose (undiluted) may be administered slowly IV over a 1 to 2 minute period:
Under 6 years of age) 0.1 mg/kg metoclopramide base
Pediatric patients 6 to 14 years of age): 2.5 to 5 mg metoclopramide base
Pediatric patients greater than 14 years: 10 mg metoclopramide base

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.

Renal Dose Adjustments

CrCl less than 40 mL/min:
Initial dose: 50% of the usual recommended dose
Subsequent dose adjustments should be made according to patient response and tolerability.

Liver Dose Adjustments

-This drug undergoes minimal hepatic metabolism, except for simple conjugation. Its safe use has been described in patients with advanced liver disease whose renal function was normal.
-When this drug was administered with other drugs with known hepatotoxic potential, rare cases of hepatotoxicity characterized by jaundice and altered liver function tests were reported.

Dose Adjustments

-Since this drug is excreted principally through the kidneys, in those patients whose CrCl 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.
-In elderly patients a dose reduction should be considered, based on renal and hepatic function and overall frailty.
When used for the treatment of nausea and vomiting due to cytotoxic drug therapy, doses should be adjusted according to the emetogenicity of the cytotoxic drug.

Precautions

US BOXED WARNINGS:
-TARDIVE DYSKINESIA: Chronic long-term or high dose use of this drug has been linked to tardive dyskinesia (TD) a potentially irreversible and disfiguring disorder characterized by involuntary movements of the face, tongue, or extremities. The development of this condition is directly related to the length of time a patient has taken metoclopramide and the total cumulative dose. Those at greatest risk include the elderly, especially older women, and patients who have been on the drug for a long time. These symptoms are rarely reversible and there is no known treatment. However, in some patients, symptoms may lessen or resolve after metoclopramide treatment is stopped. It is recommended that metoclopramide treatment not exceed 12 weeks in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia. This drug itself may suppress, or partially suppress, the signs of TD, thereby masking the underlying disease process. The effect of this symptomatic suppression upon the long-term course of TD is unknown. Therefore, this drug should not be used for the symptomatic control of TD.

Safety and effectiveness of metoclopramide oral tablets and oral disintegrating tablets have not been established in pediatric patients (less than 18 years of age). Safety and effectiveness of metoclopramide IV have not been established in pediatric patients (less than 18 years of age) except to facilitate small bowel intubation in pediatric patients above 14 years of age.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is not dialyzable.

Other Comments

Administration advice:
-Dosage recommendations given should be strictly followed to avoid dystonic side effects.
-A minimal interval of 6 hours between 2 administrations of tablets should be respected, even in case of vomiting or rejection of the dose.
-This drug should be taken on an empty stomach at least 30 minutes before eating since food can decrease the peak concentrations of drug in the bloodstream and/or the time it takes to achieve the maximum drug level in the bloodstream.
-The dose should not be repeated if inadvertently taken with food.
-Alcohol should be avoided.
-The oral solution contains sorbitol. Patients with rare hereditary problems of fructose intolerance should not take this medicine. Methyl and propyl hydroxybenzoates are contained in this product which may cause allergic reactions (possibly delayed).
-Since the orally disintegrating tablet absorbs moisture rapidly, each dose should only be removed from the packaging just prior to taking. The tablet should be handled with dry hands and placed on the tongue. If the tablet breaks or crumbles while handling, it should be discarded and a new tablet should be removed. The tablet disintegrates on the tongue in approximately one minute (with a range of 10 seconds to 14 minutes). The tablet is designed to be taken without liquid; however, some patients may prefer to take it with a small amount of liquid.
-Oral tablets in should not be used in children under 15 years of age.
-IV injections should be given slowly over 1 to 2 minutes. IV infusions should be diluted in at least 50 mL of suitable diluent and administered over 15 minutes.
-Oral tablets should not be used in children under 15 years of age.
-Therapy should not exceed 12 weeks in duration.

Reconstitution/preparation techniques:
-The preferred parenteral solution to combine with the metoclopramide injection is sodium chloride (normal saline). Information on other solutions may be found in the manufacturer product information.
-Consult the manufacturer product information for preparation techniques.

Storage requirements:
-IV: After the metoclopramide injection is combined with the sodium chloride injection, the resulting solution can be stored frozen for up to 4 weeks.
-See manufacturer product information for further instructions.

General:
-IM administration of this drug enhances the absorption of a number of medications including the absorption of aspirin in people with migraine.
-When used in the treatment of diabetic gastroparesis this drug should be discontinued once control of diabetes has been established by diet and/or insulin.
-Extrapyramidal disorders may occur, particularly in children and young adults and/or when high doses are used.
-Patients receiving this drug for disorders associated with delayed gastric emptying should be reviewed at an early stage for response to treatment.
-If vomiting persists, the patient should be reassessed to exclude the possibility of an underlying disorder, (i.e. cerebral irritation).

Patient advice:
-Patients should be instructed to read the medication guide dispensed with their prescription initially and with each refill.
-If vomiting persists, even when you are taking this medicine, you should talk to your doctor.
-This preparation may cause drowsiness, dizziness, dyskinesia and dystonia. Affected patients should avoid driving or using machinery.

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