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Metoclopramide

Class: Prokinetic Agents
- Antiemetic Agents
- Benzamides
VA Class: AU300
Molecular Formula: C14H22ClN3O22O
CAS Number: 54143-57-6
Brands: Reglan

Medically reviewed by Drugs.com. Last updated on Nov 23, 2020.

Warning

    Tardive Dyskinesia

  • May result in tardive dyskinesia.5 267 Risk increases with increasing duration of therapy and total cumulative dose.5 267 (See Tardive Dyskinesia under Cautions.)

  • Discontinue metoclopramide in patients who develop signs or symptoms of tardive dyskinesia.5 267 There is no known treatment for tardive dyskinesia; however, symptoms may lessen or resolve in some patients after discontinuance.5 267

  • Avoid use for >12 weeks in all but rare cases where therapeutic benefit is thought to outweigh risk of developing tardive dyskinesia.5 267

Introduction

Antiemetic; stimulant of upper GI motility (prokinetic agent);1 2 3 4 5 6 7 8 9 263 267 potent dopamine-receptor antagonist.2 4 5 7 19 28 34 52 267

Uses for Metoclopramide

Diabetic Gastric Stasis

Symptomatic treatment of acute and recurrent diabetic gastric stasis (gastroparesis).5 7 32 44 76 77 78 79 80 83 84 88 89 267 Successful therapy often requires long-term, intermittent use, since diabetic gastric stasis is a chronic, recurrent disease.5 9

Postsurgical Gastric Stasis

Has been used for the symptomatic treatment of acute and chronic postsurgical gastric stasis† following vagotomy and gastric resection or vagotomy and pyloroplasty.31 37 44 49 84 113 114 115 148 149 150

Prevention of Postoperative Nausea and Vomiting

Prevention of postoperative nausea and vomiting when nasogastric suction is considered undesirable.4 125 267

Prevention of Cancer Chemotherapy-induced Emesis

Used parenterally in high doses for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy including cisplatin alone or in combination with other antineoplastic agents.97 98 99 100 101 102 103 263 267

Prevention of nausea and vomiting associated with other antineoplastic agents (e.g., cyclophosphamide, dacarbazine, doxorubicin, methotrexate) and with cancer chemotherapy regimens that do not include cisplatin.103 144 145 146 147 218 263 267

ASCO does not consider metoclopramide an appropriate first-line antiemetic for any group of patients receiving chemotherapy of high emetic risk and states that this drug should be reserved for patients unable to tolerate or refractory to first-line agents (i.e., a type 3 serotonin [5-HT3] receptor antagonist [e.g., dolasetron, granisetron, ondansetron, palonosetron] with dexamethasone and aprepitant).263

ASCO states that the combination of a 5-HT3 receptor antagonist, dexamethasone, and aprepitant is preferred in patients receiving combination chemotherapy with an anthracycline and cyclophosphamide; ASCO recommends combined therapy with a 5-HT3 receptor antagonist and dexamethasone for other chemotherapy regimens of moderate emetic risk (i.e., 31–90% incidence of emesis without antiemetics) and dexamethasone alone for chemotherapy regimens of low emetic risk (i.e., 11–30% incidence).263

In patients experiencing nausea and vomiting despite recommended prophylaxis regimens, ASCO recommends that clinicians consider adding a benzodiazepine (e.g., alprazolam, lorazepam), butyrophenone, or phenothiazine to the regimen or substituting high-dose IV metoclopramide for the 5-HT3 receptor antagonist in the regimen.263

Antiemetics can be prescribed on an as-needed basis for chemotherapy regimens with minimal emetic risk (<10% incidence of emesis without antiemetics).263

Metoclopramide has been used orally† for the prevention of chemotherapy-induced nausea and vomiting. 177 218 221 224 263 264 265 266 275 Some experts state that patients receiving oral chemotherapy requiring only as-needed (“prn”) antiemetic therapy or receiving an IV chemotherapy regimen with low emetic risk may receive oral† metoclopramide.275

Oral† metoclopramide has been effective when given in combination with dexamethasone for the prevention of delayed emesis in patients receiving chemotherapy.263 264 265 266 For prevention of delayed emesis in patients receiving cisplatin or other chemotherapy of high emetic risk, ASCO recommends the combination of dexamethasone and aprepitant.263

Intubation of the Small Intestine

Used parenterally to facilitate small intestine intubation when the tube (e.g., endoscope, biopsy tube) does not pass through the pylorus during 10 minutes of conventional maneuvers.105 106 107 109 176 267

Radiographic Examination of the Upper GI Tract

Used parenterally to stimulate gastric emptying and intestinal transit of barium when delayed emptying interferes with radiographic examination of the stomach and/or small intestine.4 43 110 184 267

Gastroesophageal Reflux

Short-term (≤12 weeks) relief of symptomatic, documented gastroesophageal reflux in adults who are unresponsive to conventional therapy (e.g., changes in lifestyle, habits, diet, weight reduction) alone.5 9 30 39 40 41 42 111 112 116 117 125 129 185 186 187 188 189 190

Regular use for this purpose has declined; proton-pump inhibitors provide greater control of acid reflux.258 273 274 Some experts recommend against use of metoclopramide for this purpose based on the drug’s adverse effect profile and lack of high-quality supporting data.273 274

Metoclopramide Dosage and Administration

Administration

Administer orally, by direct IV injection or IV infusion, or IM.5 263 267

Metoclopramide therapy should not exceed 12 weeks’ duration.5 267 268 269

Oral Administration

Metoclopramide oral solution and tablets are recommended for use in adults only.5 268 269

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Dilution

For direct IV injection, use without further dilution.267

If dose is >10 mg, dilute in 50 mL of a compatible IV solution.267

For IV infusion, manufacturer recommends dilution in 50 mL of 5% dextrose, 0.9% sodium chloride, 5% dextrose and 0.45% sodium chloride, Ringer’s, or lactated Ringer’s injection.267

Manufacturer states that 0.9% sodium chloride injection is preferred because metoclopramide hydrochloride is most stable in this solution.267

Rate of Administration

Direct IV injection: Administer each 10 mg slowly over 1–2 minutes.267 Rapid IV injection may cause transient but intense feelings of anxiety and restlessness, followed by drowsiness.267

IV infusion: Administer slowly over ≥15 minutes.267

IM Administration

Inject without further dilution.267

Dosage

Available as metoclopramide hydrochloride; dosage expressed in terms of metoclopramide.5 267

Pediatric Patients

Intubation of the Small Intestine
IV

Children <6 years of age: Usually, one 0.1-mg/kg dose given by direct IV injection.267

Children 6–14 years of age: Usually, one 2.5- to 5-mg dose given by direct IV injection.267

Children >14 years of age: Usually, one 10-mg dose given by direct IV injection.267

Adults

Diabetic Gastric Stasis
Oral

10 mg 4 times daily, given 30 minutes before meals and at bedtime.5 Continue for 2–8 weeks, depending on response and likelihood of continued well-being if drug is discontinued.5 Reinstitute at earliest symptom recurrence.5

IV

If symptoms are severe or oral use is not feasible, 10 mg 4 times daily, given by direct IV injection 30 minutes before meals and at bedtime.5 267 Continued use for up to 10 days may be required until symptoms subside enough to allow oral administration;5 267 however, thoroughly assess the risks and benefits prior to continuing therapy.267

IM

If symptoms are severe or oral use is not feasible, 10 mg 4 times daily, given 30 minutes before meals and at bedtime.5 267 Continued use for up to 10 days may be required until symptoms subside enough to allow oral administration;5 267 however, thoroughly assess the risks and benefits prior to continuing therapy.267

Prevention of Postoperative Nausea and Vomiting
IM

Manufacturer states that usual dose is 10 mg administered near the end of the surgical procedure; 20 mg also may be used.267

Prevention of Cancer Chemotherapy-induced Emesis
Oral†

Some experts state that patients receiving IV chemotherapy regimens with low emetic risk may receive 10–40 mg of metoclopramide before the chemotherapy dose and then every 4 or 6 hours as needed.275

Some experts state that patients receiving oral chemotherapy requiring only as-needed (“prn”) antiemetic therapy may receive 10–40 mg of metoclopramide before the chemotherapy dose and then every 4 or 6 hours as needed.275

When given in combination with dexamethasone in clinical trials for the prevention of delayed emesis (i.e., vomiting occurring ≥24 hours after chemotherapy), 20–40 mg (or 0.5 mg/kg) of metoclopramide has been given 2–4 times daily for 3 or 4 days.263 264 265 266

IV

Manufacturer states that metoclopramide usually is given by IV infusion 30 minutes before administration of chemotherapy, and then repeated every 2 hours for 2 additional doses followed by every 3 hours for 3 additional doses.267 Manufacturer states that initial 2 doses should be 2 mg/kg if highly emetogenic chemotherapy used;267 for less emetogenic drugs or regimens, initial 1-mg/kg dose may be sufficient.267 However, combinations of other antiemetic agents generally are preferred as first-line regimens in patients receiving chemotherapy of moderate or high emetic risk (see Prevention of Cancer Chemotherapy-induced Emesis under Uses). 263 275

Some experts state that patients receiving IV chemotherapy regimens with low emetic risk may receive 10–40 mg of metoclopramide before the chemotherapy dose and then every 4 or 6 hours as needed.275

Intubation of the Small Intestine
IV

Usually, one 10-mg dose given by direct IV injection.267

Radiographic Examination of the Upper GI Tract
IV

Usually, one 10-mg dose given by direct IV injection.267

Gastroesophageal Reflux
Oral

Usually, 10–15 mg up to 4 times daily (30 minutes before each meal and at bedtime) for 4–12 weeks, depending on symptoms and response.5 Patients sensitive to therapeutic and/or adverse effects of metoclopramide may require initial dose of 5 mg.5

For intermittent symptoms or symptoms at specific times of the day, one 20-mg dose before the provoking situation may be preferred to daily administration of multiple doses.5

In patients with esophageal erosion and ulceration, 15 mg 4 times daily for 12 weeks has provided healing; monitor endoscopically because of the poor correlation between symptoms and healing.5

Prescribing Limits

Adults

Avoid use of metoclopramide for >12 weeks in all but rare cases where therapeutic benefit is thought to outweigh risk of developing tardive dyskinesia.5 267 (See Boxed Warning and see Tardive Dyskinesia under Cautions.)

Gastroesophageal Reflux
Oral

Safety and efficacy beyond 12 weeks not established; use beyond 12 weeks not recommended.5

Special Populations

Hepatic Impairment

Dosage modification does not appear to be necessary.5 267

Renal Impairment

Modify dosage according to degree of renal impairment.5 54 58 59 135 142 267

In patients with Clcr <40 mL/minute, manufacturers recommend an initial dosage of approximately 50% of the usual dosage.5 267 Subsequently, increase or decrease dosage according to response and tolerance.5 267

Geriatric Patients

Select dosage with caution, usually initiating therapy at the low end of the dosage range.5 267

Administer lowest effective dosage.5 267 In geriatric patients with gastroesophageal reflux, initial 5-mg dose may be required due to possible sensitivity to therapeutic and/or adverse effects of metoclopramide.5

Detailed Metoclopramide dosage information

Cautions for Metoclopramide

Contraindications

  • Mechanical obstruction or perforation or other situations in which stimulation of GI motility might be dangerous.5 267

  • GI hemorrhage5 267 (however, has been used to empty the stomach of blood prior to endoscopy in patients with acute upper GI hemorrhage).4 125

  • Pheochromocytoma (due to potential for hypertensive crisis).5 267

  • History of seizure disorders.4 5 267

  • Concomitant therapy with drugs likely to cause extrapyramidal reactions (e.g., phenothiazines, butyrophenones).4 5 267

  • Known intolerance to metoclopramide.5 267

  • Known hypersensitivity to metoclopramide or any ingredient in the formulation.5 267

Warnings/Precautions

Warnings

Tardive Dyskinesia

Tardive dyskinesia, a syndrome of potentially irreversible, involuntary, dyskinetic movements involving the tongue, face, mouth, or jaw, and sometimes the trunk and/or extremities, may occur; movements may be choreoathetotic in appearance.5 93 94 130 157 158 159 267 270 271 272 (See Boxed Warning.)

Reported in about 20% of patients receiving the drug for ≥12 weeks.5 267 270 271 Avoid use of metoclopramide for >12 weeks in all but rare cases where therapeutic benefit is thought to outweigh risk of developing tardive dyskinesia.5 267 272

Although risk of developing tardive dyskinesia may be increased in geriatric patients, women, and patients with diabetes mellitus, it is not possible to predict which patients will develop metoclopramide-induced tardive dyskinesia.5 267 270 271 272 Risk of occurrence and irreversibility increases with increasing duration of therapy and total cumulative dose.5 267 271 272

Discontinue metoclopramide in patients who develop signs or symptoms of tardive dyskinesia.5 267 270 271 There is no known effective treatment for tardive dyskinesia; however, tardive dyskinesia may remit, either partially or completely, in some patients within several weeks to months after discontinuance.5 267 271

Metoclopramide may suppress or partially suppress signs of tardive dyskinesia, thereby masking the underlying disease process; effect of this suppression on the long-term course of tardive dyskinesia is unknown.5 267 Do not use metoclopramide for symptomatic control of tardive dyskinesia.5 267

Extrapyramidal Symptoms

Potential for extrapyramidal reactions,4 5 90 91 125 169 205 206 207 267 especially in pediatric patients and adults <30 years of age or when high doses (e.g., IV doses for prophylaxis of cancer chemotherapy-induced nausea and vomiting) are administered.5 91 169 267

Commonly manifested as acute dystonic reactions or akathisia; stridor and dyspnea (possibly due to laryngospasm) reported rarely.5 267

Generally occur within 24–48 hours after starting therapy5 205 206 207 267 and usually subside within 24 hours following drug discontinuance.4 90 205

Most patients respond rapidly to treatment with diazepam4 or an agent with central anticholinergic activity (e.g., diphenhydramine hydrochloride 20–50 mg orally, IM, or IV;5 267 275 276 benztropine 1–2 mg IM5 267 ).4 5 170 206 207 267

Parkinsonian Symptoms

Parkinsonian symptoms (e.g., tremor, rigidity, bradykinesia, akinesia) occur rarely; may be associated with usual160 or excessive metoclopramide doses62 or decreased renal function.9 54

Possible exacerbation of parkinsonian symptoms;5 9 54 62 160 267 use with caution, if at all, in patients with parkinsonian syndrome.5 267

More common during first 6 months of therapy but occur occasionally after longer periods.5 267

Symptoms generally subside within 2–3 months following drug discontinuance.5 267

Neuroleptic Malignant Syndrome (NMS)

NMS (characterized by hyperthermia, varying levels of consciousness, muscular rigidity, and autonomic dysfunction) reported rarely.5 208 267

Important to determine whether untreated or inadequately treated extrapyramidal reactions and serious medical illness (e.g., pneumonia, systemic infection) may coexist.5 267 Also consider the possibility of central anticholinergic toxicity, heat stroke, malignant hyperthermia, drug fever, and primary CNS pathology.5 267

Immediately discontinue metoclopramide and other drugs not considered essential, provide intensive symptomatic treatment, monitor patient, and treat any concomitant serious medical condition for which specific therapies are available.5 267 Dantrolene and bromocriptine have been used in the treatment of NMS, but their efficacy has not been established and there currently is no specific drug therapy.5 267

Depression

Mild to severe depression (including suicidal ideation and suicide) has occurred in patients with or without prior history of depression.5 210 211 215 267

Use with extreme caution and only when anticipated benefits outweigh possible risks in patients with a history of mental depression, especially those with suicidal tendencies.5 267

Sensitivity Reactions

Procainamide Cross-sensitivity

Theoretical potential for patients who are allergic to procainamide to exhibit cross-sensitivity to metoclopramide (since the drugs are structurally similar).11 12

General Precautions

GI Anastomosis or Closure

When deciding whether to use metoclopramide or NG suction to prevent postoperative nausea and vomiting, consider the possibility that metoclopramide theoretically could produce increased pressure on suture lines following GI anastomosis or closure.267

Fluid and Electrolyte Effects

Possible transient increases in plasma aldosterone concentrations and sodium retention; closely monitor patients (e.g., those with CHF or cirrhosis) at risk of developing fluid retention and volume overload or hypokalemia.3 5 69 267

Discontinue metoclopramide if fluid retention or volume overload occurs at any time during therapy.5 267

Hypertension

Possible increase in circulating catecholamines in hypertensive patients; use with caution in these patients.5 267

CNS Depression

Drowsiness may occur, particularly at higher dosages.5 267 Performance of activities requiring mental alertness and physical coordination (operating machinery, driving a motor vehicle) may be impaired.5 267

Withdrawal Effects

Adverse reactions, particularly CNS reactions, may occur following discontinuance of drug.5 Some patients may experience withdrawal symptoms including dizziness, nervousness, and/or headaches following discontinuance.5

Patients with Cytochrome-b5 Reductase Deficiency

Patients with cytochrome-b5 reductase deficiency have an increased risk of methemoglobinemia and/or sulfhemoglobinemia when metoclopramide is administered.5 267

Patients with Glucose-6-phosphate Dehydrogenase Deficiency

Methylene blue is not recommended for treatment of metoclopramide-induced methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.5 267

Specific Populations

Pregnancy

Category B.5 267

Lactation

Distributed into milk.5 139 140 267 Use caution in nursing women.5 267

Pediatric Use

Manufacturers currently recommend use in children only to facilitate intubation of the small intestine;267 however, has been effective for the management of gastric stasis†178 180 181 and gastroesophageal reflux†179 182 in infants and children.

Use with caution; incidence of extrapyramidal reactions is increased in children.5 91 125 156 267

Use with caution in neonates.5 267 Neonatal susceptibility to methemoglobinemia is increased due to prolonged clearance (may cause excessive serum concentrations) in combination with decreased neonatal levels of cytochrome-b5 reductase.5 267

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.5 267

Possible increased risk of tardive dyskinesia.5 267

Risk of adverse parkinsonian effects increases with increasing dosage; administer lowest effective dosage in geriatric patients.5 267 If parkinsonian symptoms develop, generally should discontinue metoclopramide before initiating specific antiparkinsonian therapy.5 267

Confusion and oversedation may occur.5 267

Substantially eliminated by kidneys; risk of adverse reactions may be greater in patients with impaired renal function.5 267 (See Renal Impairment under Dosage and Administration.)

Select dosage with caution because of age-related decreases in renal function and concomitant disease and drug therapy.5 267 (See Geriatric Patients under Dosage and Administration).

Hepatic Impairment

Possible increased risk of fluid retention and hypokalemia in patients with cirrhosis.3 5 69 267 (See Fluid and Electrolyte Effects under Cautions.)

Discontinue if fluid retention or volume overload occurs at any time during therapy.5 267

Renal Impairment

Clearance may be reduced.5 54 59 142 192 267 Possible increased risk of adverse effects.5 267 Use with caution; reduce dosage during prolonged therapy in patients with renal impairment.5 54 58 59 69 135 142 267 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Restlessness, drowsiness, fatigue, lassitude, nausea, bowel disturbances (principally diarrhea).4 5 90 125 267

Interactions for Metoclopramide

Orally Administered Drugs

Possible decreased absorption of certain drugs that disintegrate, dissolve, and/or are absorbed mainly in the stomach.4 5 119 125 267 Clinical importance not determined.c

Possible enhanced rate and extent of absorption of drugs mainly absorbed in the small intestine.4 5 120 125 267 Clinical importance not determined.c

Specific Drugs

Drug

Interaction

Comments

Acetaminophen

Possible enhanced rate and extent of acetaminophen absorption4 5 120 125 267

Clinical importance not determinedc

Anesthetic agents

Acute hypotension reported with concomitant IV metoclopramide and hypotensive anesthetic agents (with or without ganglionic blocking agents) during neurosurgical procedures162 163

Clinical importance not known125 162 163

Anticholinergic agents (e.g., atropine)

Antagonism of GI motility effects of metoclopramide 5 267

Aspirin

Possible enhanced rate and extent of aspirin absorption4 120 125

Clinical importance not determinedc

Butyrophenones

Potential for extrapyramidal reactions4 5 267 and worsening of symptoms in patients with parkinsonian syndrome130 158 160

Concomitant use contraindicated4 5 267

Cholinergic agents

Potentiation of GI motility effects of metoclopramide5

CNS depressants (alcohol, opiates or other analgesics, barbiturates or other sedatives, anesthetics)

Increased CNS depressant effects;5 267 possible enhanced rate and extent of alcohol absorption4 5 125 267

Use caution to avoid excessive sedation;c clinical importance of enhanced alcohol absorption not determinedc

Cyclosporine

Possible enhanced rate and extent of cyclosporine absorption4 5 120 125 267

Clinical importance not determinedc

Diazepam

Possible enhanced rate and extent of diazepam absorption4 120 125

Clinical importance not determinedc

Digoxin

Possible decreased digoxin absorption; Lanoxin tablets apparently not affected because of small drug-particle size and rapid absorption4 5 119 125 267

Insulin

Possible alteration of glycemic control secondary to metoclopramide-related changes in the delivery of food to and the rate of absorption in the intestine5 267

Adjustment of insulin dose or timing may be necessary5 267

Levodopa

Possible enhanced rate and extent of levodopa absorption4 5 120 125 267

Clinical importance not determinedc

Lithium

Possible enhanced rate and extent of lithium absorption4 120 125

Clinical importance not determinedc

MAO inhibitors

Possible hypertensive reaction due to metoclopramide-induced release of catecholamines5 267

Use with caution, if at all5 267

Opiate analgesics

Antagonism of GI motility effects of metoclopramide5 15 33 267

Phenothiazines

Potential for extrapyramidal reactions4 5 267 and worsening of symptoms in patients with parkinsonian syndrome130 158 160

Concomitant use contraindicated4 5 267

Tetracycline

Possible enhanced rate and extent of tetracycline absorption4 5 120 125 267

Clinical importance not determinedc
Metoclopramide drug interactions (more detail)

Metoclopramide Pharmacokinetics

Absorption

Bioavailability

Following oral administration, rapidly and almost completely absorbed;4 5 7 53 54 55 56 133 134 135 267 limited data indicate that 30–100% of an oral dose reaches systemic circulation as unchanged metoclopramide.5 54 56 133 134 135 267 Peak plasma concentration usually attained at 1–2 hours.5 55 267

Following IM administration, absolute bioavailability is 74–96%.7

Onset

Following oral administration, 30–60 minutes for effects on GI tract.5 7 267

Following IM administration, 10–15 minutes for effects on GI tract.5 7 267

Following IV administration, 1–3 minutes for effects on GI tract.5 7 267

Duration

1–2 hours.5 267

Special Populations

In patients with gastric stasis, absorption may be delayed or diminished.14

In infants, metoclopramide may accumulate in plasma after multiple doses; mean peak plasma concentration was 2-fold higher after 10th dose compared with that after first dose in infants (3.5 weeks–5.4 months of age) with gastroesophageal reflux receiving metoclopramide oral solution.5 267

Distribution

Extent

In mice, distributed into most body tissues and fluids; high concentrations in GI mucosa, liver, biliary tract, and salivary glands, with lower concentrations in brain, heart, thymus, adrenals, adipose tissue, and bone marrow.4 7

Crosses the placenta138

Distributed into milk in humans;5 139 140 267 milk concentrations are higher than plasma concentrations 2 hours after oral administration.139 140

Plasma Protein Binding

13–30% (principally albumin).5 7 267

Elimination

Metabolism

Minimally metabolized; not known whether major metabolite found in urine is active.5 53 267

Elimination Route

Excreted in urine (85%) as unchanged drug and metabolites5 7 53 54 133 267 and also in feces (about 5%).7 53

Minimally removed by hemodialysis5 129 192 267 or peritoneal dialysis.5 129 267

Half-life

Biphasic; terminal-phase half-life is 2.5–6 hours in adults.5 53 56 57 267

Elimination half-life is about 4.1–4.5 hours in children.5 267

Special Populations

In patients with renal impairment, half-life may be prolonged and plasma concentrations increased.5 54 59 142 192 267

Reduced neonatal clearance, possibly associated with immature renal and hepatic functions present at birth.5 267

Stability

Storage

Oral

Tablets

Tight, light-resistant containers at 20–25°C.5 194 216

Solution

Tight, light-resistant containers at 20–25°C.194 216 268 269

Parenteral

Injection

20–25°C.267 Protect from light.267

Following dilution with 5% dextrose, 0.9% sodium chloride, 5% dextrose and 0.45% sodium chloride, Ringer’s, or lactated Ringer’s injection, store for up to 48 hours (without freezing) when protected from light or for up to 24 hours under normal light conditions (i.e., unprotected from light).267

May be stored frozen for up to 4 weeks following dilution with 0.9% sodium chloride injection.267

Degradation occurs if metoclopramide is diluted in 5% dextrose injection and frozen.267

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility267 HID

Compatible

Amino acids 2.75%, dextrose 25%, electrolytesHID

Dextrose 5% in water267 HID

Dextrose 5% in sodium chloride 0.45%267 HID

Mannitol 20%HID

Ringer’s injection267

Ringer’s injection, lactated267

Sodium chloride 0.9%267 HID

Manufacturer states that sodium chloride 0.9% is preferred diluent because metoclopramide hydrochloride is most stable in this solution.267

Drug Compatibility
Admixture CompatibilityHID

Compatible

Clindamycin phosphate

Meperidine HCl

Meropenem

Morphine sulfate

Multivitamins

Potassium acetate

Potassium chloride

Potassium phosphates

Verapamil HCl

Incompatible

Dexamethasone sodium phosphate with lorazepam and diphenhydramine HCl

Erythromycin lactobionate

Fluorouracil

Furosemide
Y-Site CompatibilityHID

Compatible

Aldesleukin

Amifostine

Aztreonam

Bivalirudin

Bleomycin sulfate

Ceftaroline fosamil

Ciprofloxacin

Cisatracurium besylate

Cisplatin

Cladribine

Clarithromycin

Cyclophosphamide

Dexmedetomidine HCl

Diltiazem HCl

Docetaxel

Doripenem

Doxapram HCl

Doxorubicin HCl

Droperidol

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Fentanyl citrate

Filgrastim

Fluconazole

Fludarabine phosphate

Fluorouracil

Foscarnet sodium

Gallium nitrate

Gemcitabine HCl

Granisetron HCl

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydromorphone HCl

Idarubicin HCl

Leucovorin calcium

Levofloxacin

Linezolid

Melphalan HCl

Meperidine HCl

Meropenem

Methadone HCl

Methotrexate sodium

Mitomycin

Morphine sulfate

Ondansetron HCl

Oxaliplatin

Paclitaxel

Palonosetron HCl

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Quinupristin-dalfopristin

Remifentanil HCl

Sargramostim

Tacrolimus

Telavancin HCl

Teniposide

Thiotepa

Tigecycline

Topotecan HCl

Vinblastine sulfate

Vincristine sulfate

Vinorelbine tartrate

Zidovudine

Incompatible

Allopurinol sodium

Amphotericin B cholesteryl sulfate complex

Doxorubicin HCl liposome injection

Furosemide

Variable

Acyclovir sodium

Actions

  • Complex pharmacology; mechanism(s) of action not fully elucidated; principal effects involve the GI tract and CNS.3 4 5 6 7 8 9 11 12 13 14 125 267

  • At low concentrations in vitro, metoclopramide increases the resting tone and phasic contractile activity of GI smooth muscle.8 16 21

  • Increases lower esophageal sphincter pressure.4 125

  • Accelerates gastric emptying and intestinal transit from the duodenum to the ileocecal valve by increasing the amplitude and duration of esophageal contractions,4 resting tone of the lower esophageal sphincter,5 7 8 30 39 40 41 42 267 and amplitude and tone of gastric (especially antral) contraction 5 7 9 16 25 33 37 38 43 44 267 and by relaxing the pyloric sphincter and the duodenal bulb, while increasing peristalsis of the duodenum and jejunum.5 7 25 33 38 43 45 48 49 267

  • Unlike nonspecific cholinergic-like stimulation of upper GI smooth muscle, the stimulant effects of metoclopramide on GI smooth muscle coordinate gastric, pyloric, and duodenal motor activity.25 33 38

  • Precise mechanism of antiemetic action is unclear.2 4 8 52 60 61 103 125 219 220 221 222 223 224 225 226 227 Directly affects medullary chemoreceptor trigger zone (CTZ), apparently by blocking dopamine receptors;2 4 8 52 60 61 103 125 219 220 221 222 223 224 225 226 227 increases CTZ threshold and decreases sensitivity of visceral nerves that transmit impulses from GI tract to vomiting center;4 and enhances gastric emptying (believed to minimize stasis that precedes vomiting).4 125 Also may inhibit serotonin (5-HT3) receptors (at relatively high doses).219 220 223 224 225 226 227

  • Produces varying degrees of sedation and lethargy.4

  • May cause extrapyramidal reactions4 5 267 and worsen symptoms in patients with parkinsonian syndrome.5 130 158 160 267

Advice to Patients

  • Importance of providing patient or caregiver with a copy of the manufacturer’s medication guide; discuss and answer questions about its contents as needed.5 267 Importance of instructing patient or caregiver to read and understand the contents of the medication guide before initiating therapy and each time the prescription is refilled.5 267

  • Importance of informing patients that metoclopramide oral solution and tablets are recommended for use in adults only.5 268 269

  • Risk of tardive dyskinesia.5 267 Importance of contacting clinicians if new, abnormal, involuntary, or uncontrollable muscle movements occur (e.g., lip smacking, chewing, puckering mouth, frowning, scowling, tongue protrusion, blinking, eye movements, arm and leg shaking).5 267

  • Potential for metoclopramide to impair mental alertness or physical coordination; avoid driving or operating machinery until effects on individual are known.5 267

  • Potential for metoclopramide to enhance sedative effects of alcohol, barbiturates, or other CNS depressants.5 267

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.5 267

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.5 267

  • Importance of informing patients of other important precautionary information.5 267 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Metoclopramide Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution

5 mg (of metoclopramide) per 5 mL*

Metoclopramide Hydrochloride Syrup

Tablets

5 mg (of metoclopramide)*

Metoclopramide Hydrochloride Tablets

Reglan

Alaven

10 mg (of metoclopramide)*

Metoclopramide Hydrochloride Tablets

Reglan (scored)

Alaven

Parenteral

Injection

5 mg (of metoclopramide) per mL*

Metoclopramide Hydrochloride Injection

Reglan

Baxter

AHFS DI Essentials™. © Copyright 2021, Selected Revisions December 1, 2014. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

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