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metoclopramide

Pronunciation

Generic Name: metoclopramide (MET oh KLOE pra mide)
Brand Name: 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.

What is the most important information I should know 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 uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. 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).

What should I discuss with my healthcare provider 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, a heart rhythm disorder;

  • high blood pressure;

  • breast cancer;

  • Parkinson's disease;

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

  • depression or mental illness.

FDA pregnancy category B. This medication 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.

The metoclopramide orally disintegrating tablet (ODT) may contain phenylalanine. Talk to your doctor before using this form of metoclopramide if you have phenylketonuria (PKU).

Metoclopramide should not be given to a child.

How should I take metoclopramide?

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

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 uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. 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 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 (ODT):

  • Keep the tablet in its bottle or blister pack until you are ready to take the medicine. Make sure your hands are dry before handling a tablet. If the tablet breaks or melts in your hand, throw it away and use a new tablet.

  • Place the tablet on your tongue. It will begin to melt right away. Do not swallow the tablet whole. Allow it to melt in your mouth without chewing.

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

Do not take two different forms of metoclopramide (such as tablets and oral syrup) at the same time.

Store 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.

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.

Metoclopramide side effects

Get emergency medical help if you have any of these signs of an allergic reaction: 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 SIGNS OF A SERIOUS MOVEMENT DISORDER, which may occur within the first 2 days of treatment:

  • tremors or shaking in your arms or legs;

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or

  • any new or unusual muscle movements you cannot control.

Stop taking metoclopramide and call your doctor at once if you have any of these other serious side effects:

  • slow or jerky muscle movements, problems with balance or walking;

  • mask-like appearance in your 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, feeling short of breath, rapid weight gain;

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

  • seizure (convulsions).

Less serious 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: Side effects (in more detail)

Metoclopramide dosing information

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

EMETOGENIC CANCER CHEMOTHERAPY:
Parenteral:
-Initial dose: 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.
-Subsequent doses: The dose should be repeated every 2 hours for 2 doses following the initial dose, then every 3 hours for 3 additional doses.

Comments:
-The initial 2 doses should be given at 2 mg/kg with highly emetogenic chemotherapy regimens and 1 mg/kg with less emetogenic regimens.
-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.

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

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

Usual Adult Dose for Nausea/Vomiting -- Postoperative:

EMETOGENIC CANCER CHEMOTHERAPY:
Parenteral:
-Initial dose: 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.
-Subsequent doses: The dose should be repeated every 2 hours for 2 doses following the initial dose, then every 3 hours for 3 additional doses.

Comments:
-The initial 2 doses should be given at 2 mg/kg with highly emetogenic chemotherapy regimens and 1 mg/kg with less emetogenic regimens.
-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.

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

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

Usual Adult Dose for Small Intestine Intubation:

If the tube has not passed the pylorus with conventional maneuvers in 10 minutes, a single undiluted dose may be administered via slow IV.
Parenteral:
-Recommended single dose: 10 mg IV metoclopramide base over a 1 to 2 minute period

Use:
-To facilitate small bowel intubation

Usual Adult Dose for Radiographic Exam:

In patients where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine, a single IV dose may be administered.
Parenteral:
-Recommended single dose: 10 mg IV metoclopramide base over a 1 to 2 minute period

Use:
-To facilitate gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

Usual Adult Dose for Gastroparesis:

Initial route:
-Oral administration may be initiated in the earliest manifestations of diabetic gastric stasis.
-IM/IV administration for up to 10 days if severe symptoms are present; once symptoms subside, the patient may be switched to oral therapy.
Recommended dose:
-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

Comment:
-Since diabetic gastric stasis is often recurrent, therapy should be reinstituted at the earliest manifestation.

Use:
-For the relief of symptoms associated with diabetic gastric stasis/gastroparesis

Usual Adult Dose for Gastroesophageal Reflux Disease:

Oral:
-Recommended dose: 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
-Intermittent symptoms/at specific times of day: 20 mg orally once a day prior to provoking situation
-Use with esophageal erosions/ulcerations: 15 mg orally 4 times a day, if tolerated
-Maximum duration of therapy: 12 weeks

Comments:
-Geriatric patients and those who are more sensitive to adverse effects may require an oral dose of 5 mg.
-Because of the poor correlation between symptoms and endoscopic appearance of the esophagus, therapy directed at esophageal lesions is best guided by endoscopic evaluation.

Use:
-For the relief of symptomatic gastroesophageal reflux disease (GERD)

Usual Pediatric Dose for Small Intestine Intubation:

If the tube has not passed the pylorus with conventional maneuvers in 10 minutes, a single undiluted dose may be administered via slow IV.
Parenteral:
6 years or younger: 0.1 mg/kg metoclopramide base IV over a 1 to 2 minute period
6 to 14 years: 2.5 to 5 mg metoclopramide base IV over a 1 to 2 minute period
14 years or older: 10 mg metoclopramide base IV over a 1 to 2 minute period

Comment:
-A single dose IV may be used if delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

Uses:
-To facilitate small bowel intubation
-To aid in radiological examinations by causing gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

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);

  • blood pressure medications;

  • 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.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 11.01. Revision Date: 2012-02-15, 10:50:13 AM.

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