Metoclopramide

Generic Name: metoclopramide (MET oh KLOE pra mide)
Brand Names: Metozolv ODT, Reglan

What is metoclopramide?

Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.

Metoclopramide is used short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of symptoms.

Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.

Metoclopramide may also be used for purposes not listed in this medication guide.

Important information about metoclopramide

NEVER TAKE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include tremors or other uncontrollable muscle movements. The longer you take metoclopramide, 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 metoclopramide, 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 metoclopramide, 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 metoclopramide. There are many other medicines that can interact with metoclopramide. 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 metoclopramide 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).

Before taking metoclopramide

You should not take this medication if you are allergic to metoclopramide, or if you have:

• bleeding or blockage in your stomach or intestines;

• a perforation (hole) in your stomach or intestines;

• epilepsy or other seizure disorder; or

• an adrenal gland tumor (pheochromocytoma).

To make sure you can safely take metoclopramide, tell your doctor if you have any of these other conditions:

• kidney disease;
• liver disease (especially cirrhosis);

• congestive heart failure;

• high blood pressure;

• Parkinson's disease;

• diabetes (your insulin dose may need adjusting); or

• a history of depression.

FDA pregnancy category B. Metoclopramide is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Metoclopramide can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Metoclopramide should not be given to a child.

See also: Metoclopramide pregnancy and breastfeeding warnings (in more detail)

How should I take metoclopramide?

NEVER TAKE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include tremors or other uncontrollable muscle movements. The longer you take metoclopramide, 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.

Take exactly as prescribed by your doctor. Metoclopramide is usually taken for only 4 to 12 weeks. Follow the directions on your prescription label.

Take metoclopramide 30 minutes before eating. Metoclopramide is usually taken before meals and at bedtime. Your doctor may want you to take the medication as needed only with meals that usually cause heartburn. Follow your doctor's instructions.

Measure the liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

To take metoclopramide orally disintegrating tablet (Metozolv):

• Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. If the tablet breaks, throw it away and take out a new one.

• Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

• Swallow several times as the tablet dissolves. You do not need to drink liquid to help the tablet dissolve.

Store metoclopramide at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

After you stop taking metoclopramide, you may have unpleasant withdrawal symptoms such as headache, dizziness, or nervousness. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

See also: Metoclopramide dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, confusion, tremors or uncontrolled muscle movements in your face or neck, or seizure (convulsions).

What should I avoid while taking metoclopramide?

Avoid drinking alcohol. It can increase some of the side effects of metoclopramide. Metoclopramide may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

See also: Metoclopramide and alcohol (in more detail)

Metoclopramide side effects

Get emergency medical help if you have any of these signs of an allergic reaction to metoclopramide: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking metoclopramide and call your doctor at once if you have any of these serious side effects:

• tremors, or restless muscle movements in your eyes, tongue, jaw, neck, arms, or legs;

• mask-like appearance of the face;

• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;

• depressed mood, thoughts of suicide or hurting yourself;

• hallucinations, anxiety, agitation, jittery feeling, trouble staying still;

• swelling, fluid retention;

• jaundice (yellowing of your skin or eyes); or

• seizure (convulsions).

Less serious metoclopramide side effects may include:

• feeling restless, drowsy, tired, or dizzy;

• headache, sleep problems (insomnia);

• nausea, vomiting, diarrhea;

• breast tenderness or swelling;

• changes in your menstrual periods; or

• urinating more than usual.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Metoclopramide side effects (in more detail)

Metoclopramide Dosing Information

Usual Adult Metoclopramide Dose for Nausea/Vomiting:

Parenteral: 10 to 20 mg IV or IM at or near the end of surgery and repeated every 4 to 6 hours as needed.

Usual Adult Dose for Gastroesophageal Reflux Disease:

Parenteral: 10 to 15 mg, IV or IM, 4 times a day 30 minutes before meals and at bedtime.

Oral: 10 to 15 mg 4 times a day 30 minutes before meals and at bedtime. Therapy should generally not exceed 12 weeks.

Usual Adult Metoclopramide Dose for Small Intestine Intubation:

10 mg IV one time during the procedure.

Usual Adult Dose for Radiographic Exam:

10 mg IV one time to facilitate gastric emptying.

Usual Adult Metoclopramide Dose for Gastroparesis:

Parenteral: 10 mg 4 times a day, IV or IM, 30 minutes before meals and at bedtime. Therapy should generally be continued for 2 to 8 weeks.

Oral: 10 mg 4 times a day 30 minutes before meals and at bedtime. Therapy should generally be continued for 2 to 8 weeks.

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

IV infusion: 1 to 2 mg/kg/dose (depending on the emetogenic potential of the agent) IV 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. If vomiting is suppressed following 3 doses, the dose may be decreased by 50% for 3 doses at 3 hour intervals.

Usual Adult Dose for Migraine:

10 to 20 mg IV once.

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

Less than or equal to 14 years: 0.1 to 0.2 mg/kg/dose IV; repeat every 6 to 8 hours as needed.

Greater than 14 years: 10 mg IV; repeat every 6 to 8 hours as needed.

Usual Pediatric Metoclopramide Dose for Gastroesophageal Reflux Disease:

Neonates, Infants, and Children: Oral, IM, or IV: 0.4 to 0.8 mg/kg/day in 4 divided doses.

Usual Pediatric Dose for Small Intestine Intubation:

Less than 6 years: 0.1 mg/kg IV one time

6 to 14 years: 2.5 to 5 mg IV one time

Greater than 14 years: 10 mg as a single dose

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

Oral or IV:
1 to 2 mg/kg/dose every 2 to 4 hours (maximum of 5 doses/day); pretreatment with diphenhydramine will decrease risk of extrapyramidal reactions to this dosage.

What other drugs will affect metoclopramide?

Before using metoclopramide, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by metoclopramide.

Tell your doctor about all other medications you use, especially:

• acetaminophen (Tylenol);

• cyclosporine (Gengraf, Neoral, Sandimmune);

• digoxin (digitalis, Lanoxin);

• glycopyrrolate (Robinul);

• insulin;

• levodopa (Larodopa, Atamet, Parcopa, Sinemet);

• mepenzolate (Cantil);

• tetracycline (Ala-Tet, Brodspec, Panmycin, Sumycin, Tetracap);

• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);

• bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

• bronchodilators such as ipratroprium (Atrovent) or tiotropium (Spiriva);

• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin), or propantheline (Pro-Banthine);

• an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (Clozaril, FazaClo), haloperidol (Haldol), olanzapine (Zyprexa, Symbyax), prochlorperazine (Compazine), risperidone (Risperdal), thiothixene (Navane), and others.

This list is not complete and there are many other drugs that can interact with metoclopramide. 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.

Where can I get more information?

• Your pharmacist can provide more information about metoclopramide.