Metoclopramide: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 9, 2020.
1. How it works
- Metoclopramide increases the motility of the upper gastrointestinal tract, allowing faster transit of food through the GI tract and reducing symptoms such as nausea.
- Experts are not sure exactly how metoclopramide exerts this effect but suggest it is due to its effects on dopamine receptors in the brain and gut.
- Metoclopramide belongs to the class of medicines known as antiemetics. It may also be called a prokinetic.
- Used for the short-term relief (4-12 weeks) of symptomatic gastroesophageal reflux that has not responded to other doctor-prescribed treatment. When used for this purpose, metoclopramide is more likely to help daytime symptoms, especially those following a meal; its effect on night-time symptoms is less. May be effective when used prophylactically, such as a single dose before a meal.
- May also be effective for people with diabetes who have problems with gastric emptying (symptoms include nausea, vomiting, heartburn, persistent fullness after meals, and weight loss).
- Metoclopramide injection may be used to prevent nausea and vomiting associated with cancer chemotherapy, to help facilitate small bowel intubation, and to stimulate the emptying of the bowel before radiological examination of the stomach.
- Metoclopramide tablets may also be used for other indications off-label (this means its use has not been FDA-approved, but it is still a recognized use).
- Generic metoclopramide is available.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Sedation or mental impairment which may affect a person's ability to drive or operate machinery. Other side effects include restlessness, fatigue, confusion, insomnia, galactorrhea (a milky discharge from the nipples unrelated to lactation), gynecomastia (breast enlargement in males), mental depression (may include thoughts of suicide; only give to people with a history of depression if the benefits outweigh the risks).
- May cause movement disorders (such as tremor and rigidity; a mask-like face). These are called extrapyramidal symptoms and are more common within the first 6 months of treatment. These side effects may take two to three months to subside following discontinuation. Adults aged less than 30 are more at risk.
- Metoclopramide use has been associated with the development of tardive dyskinesia (TD) (a nerve disorder characterized by involuntary movements of the face and jaws). Discontinue metoclopramide if TD develops; symptoms may lessen or resolve in some patients once metoclopramide has been stopped; however, in some patients TD is irreversible and there is no known treatment. Risk increases with duration of treatment and cumulative dose and may be higher in the elderly, in women, and in diabetics. Metoclopramide should not be taken for longer than 12 weeks unless the benefits outweigh the risks.
- Rarely, may cause Neuroleptic Malignant Syndrome; symptoms include high body temperature, muscle rigidity, and mental disturbances. Discontinue metoclopramide immediately and seek urgent medical advice.
- Some people may experience withdrawal symptoms after stopping metoclopramide, such as dizziness, nervousness, or headaches.
- May not be suitable for some people including those with Parkinson's disease, epilepsy, high blood pressure, cirrhosis, kidney disease, congestive heart failure, preexisting gastrointestinal problems (such as hemorrhage, obstruction, perforation); pheochromocytoma; or previous intolerance to metoclopramide.
- May interact with a number of other drugs including narcotic analgesics, anticholinergics, digoxin, and monoamine oxidase antidepressants. May affect the absorption of some drugs.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects
- May be taken with or without food.
- Take exactly as directed by your doctor. Do not increase or decrease the dosage without his or her advice.
- Metoclopramide should only be taken by adults and preferably for less than 12 weeks duration.
- Do not drink alcohol while you are taking metoclopramide because it may make some side effects worse.
- Metoclopramide may make you sleepy and affect your ability to drive or operate machinery. Do not do these tasks if metoclopramide affects you in this way.
- Contact your doctor urgently if you develop thoughts about self-harm, an unexplained high fever, stiff muscles, problems thinking, rapid or erratic heartbeat, sweat excessively, develop new, unusual, or uncontrollable muscle movements, or have any other worrying side effects.
- Diabetics may need to adjust their insulin dosage or administration time if metoclopramide is being used to treat diabetic gastric stasis.
- Do not take any other medications, including those bought over the counter, without checking with a doctor or pharmacist that the new medication is compatible with metoclopramide.
6. Response and Effectiveness
- Metoclopramide takes about one to three minutes to start working following an intravenous dose; 10-15 minutes following an intramuscular dose; and 30-60 minutes following an oral dose. Effects last for approximately one to two hours.
Medicines that interact with metoclopramide may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with metoclopramide. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with metoclopramide include:
- anticholinergic agents, such as oxybutynin
- antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), venlafaxine, and SSRIs (eg, paroxetine, sertraline)
- anticonvulsants, such as phenytoin, phenobarbital, or primidone
- antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- medications that induce or inhibit CYP2D6 enzymes
- opioids, such as oxycodone or morphine
- other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort.
Note that this list is not all-inclusive and includes only common medications that may interact with metoclopramide. You should refer to the prescribing information for metoclopramide for a complete list of interactions.
Metoclopramide. Revised: 05/2020. Drugs.com https://www.drugs.com/ppa/metoclopramide.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use metoclopramide only for the indication prescribed.
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