Home Drug Guide Metoclopramide Hydrochloride

Drug Guide

Generic Name

Metoclopramide Hydrochloride

Brand Names Reglan, Reglan Odt, Metozolv Odt, Maxolon, Clopra, Clopra-"yellow", Metoclopramide Hcl, Metoclopramide Intensol, Metoclopramide, Gimoti

Classification

Therapeutic: Antiemetic, Gastroprokinetic agent

Pharmacological: Dopamine D2 receptor antagonist

FDA Approved Indications

Gastroesophageal reflux disease (GERD) with delayed gastric emptying
Postoperative nausea and vomiting
Chemotherapy-induced nausea and vomiting

Mechanism of Action

Metoclopramide enhances gastrointestinal motility by blocking dopamine D2 receptors in the chemoreceptor trigger zone and gut, thereby acting as an antiemetic and prokinetic agent.

Dosage and Administration

Adult: Typically 10 mg orally 30 minutes before meals and at bedtime; intravenous doses vary based on indication.

Pediatric: Dosing is weight-based; typically 0.1-0.2 mg/kg/dose 3-4 times daily, not to exceed adult doses.

Geriatric: Start at lower doses due to increased sensitivity and risk of side effects.

Renal Impairment: Dose adjustment may be necessary; consult guidelines.

Hepatic Impairment: Use with caution; monitor closely.

Pharmacokinetics

Absorption: Well absorbed orally, with variable bioavailability.

Distribution: Widely distributed, crosses the blood-brain barrier and placenta.

Metabolism: Metabolized in the liver, partly by conjugation.

Excretion: Excreted mainly in urine.

Half Life: Approximately 5-6 hours.

Contraindications

Gastrointestinal hemorrhage
Mechanical bowel obstruction
Perforation
History of tardive dyskinesia

Precautions

Use with caution in Parkinson's disease, depression, and history of neuropsychiatric disorders.
Pregnancy category B; caution during lactation.

Adverse Reactions - Common

Fatigue (Frequent)
Drowsiness (Frequent)
Restlessness, somnolence (Common)

Adverse Reactions - Serious

Tardive dyskinesia (Uncommon but serious with long-term use)
Extrapyramidal symptoms (Uncommon)
Neuroleptic malignant syndrome (Rare)

Drug-Drug Interactions

CNS depressants (enhanced sedation)
Drugs lowering seizure threshold

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for extrapyramidal symptoms, tardive dyskinesia, and neuropsychiatric effects.

Diagnoses:

Risk for neurological adverse effects
Impaired GI motility

Implementation: Administer as prescribed; monitor for side effects; assess symptom relief.

Evaluation: Effectiveness in controlling nausea/vomiting and improving gastric emptying.

Patient/Family Teaching

Do not exceed prescribed dose.
Report any involuntary movements or abnormal muscle movements.
Caution when operating machinery or driving.
Avoid alcohol and CNS depressants.

Special Considerations

Black Box Warnings:

Tardive dyskinesia, which can be irreversible, especially with long-term or high-dose use.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Drowsiness, sedation, disorientation, extrapyramidal symptoms.

Treatment: Supportive care; administer activated charcoal if ingestion was recent; monitor and manage symptoms; use of diphenhydramine or benzodiazepines for extrapyramidal reactions, as indicated.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable when stored properly; consult product label for expiration.