Metoclopramide: Uses, Side Effects, Dosage & Drug Interactions

Summary of Key Points

Metoclopramide is a prescription medication commonly used to treat nausea, vomiting, gastroparesis, and other gastrointestinal conditions. It works by enhancing the movement of the stomach and intestines, which helps alleviate symptoms such as nausea and bloating. It is also prescribed to prevent nausea caused by chemotherapy or surgery. Always consult a healthcare provider before starting or adjusting your dose. If you need guidance, you can connect with one of our telemedicine providers for assistance.

Names of Medication

US Brand Name: Reglan (Metoclopramide)

The generic name is the official medical name of the drug, while the brand name is the name given by the manufacturer. In this case, Metoclopramide is the generic name, listed in parentheses.

Pharmacologic Category

Prokinetic Agents

Antiemetics

Metoclopramide Dosage

Metoclopramide is prescribed for various conditions, and the dosage and treatment duration depend on the specific condition being treated. Always follow your doctor’s instructions and consult them before making any changes to your dose. If you need assistance, our telemedicine providers are available to help.

Metoclopramide for Nausea and Vomiting

For nausea and vomiting, the typical adult dose is 10 mg, taken 3 to 4 times a day, 30 minutes before meals and at bedtime. Treatment is generally short-term, lasting no more than 12 weeks.

Metoclopramide for Gastroparesis

For diabetic gastroparesis, the recommended dose is 10 mg, taken 30 minutes before meals and at bedtime for 2 to 8 weeks.

Metoclopramide for Gastroesophageal Reflux Disease (GERD)

For GERD, the usual dose is 10-15 mg, taken 30 minutes before meals and at bedtime. The duration of treatment varies based on the severity of symptoms.

Metoclopramide for Migraines

For migraine-associated nausea, a single dose of 10 mg may be taken at the onset of symptoms.

Metoclopramide for Chemotherapy-Induced Nausea

For nausea caused by chemotherapy, the typical dose is 1-2 mg/kg, administered 30 minutes before chemotherapy. This may be repeated every 2-4 hours, depending on the patient’s needs.

Metoclopramide for Postoperative Nausea

For nausea following surgery, a single dose of 10-20 mg may be administered.

Metoclopramide for Diabetic Gastroparesis

For diabetic gastroparesis, the dose is 10 mg, taken 30 minutes before meals and at bedtime for 2 to 8 weeks.

Metoclopramide for Functional Dyspepsia

For functional dyspepsia, the typical dose is 10 mg, taken 30 minutes before meals and at bedtime.

Metoclopramide for Intestinal Obstruction

For intestinal obstruction, the dose is 10-20 mg every 6-8 hours, depending on the severity of symptoms.

Dosage Forms and Strengths

Tablets: 5 mg, 10 mg

Oral Solution: 5 mg/5 mL

Injection: 5 mg/mL

Administration Instructions

Metoclopramide should be taken 30 minutes before meals and at bedtime, as directed by your healthcare provider. If using the oral solution, measure the dose carefully with a special measuring device. Avoid using a household spoon, as it may not provide the correct dose. If you miss a dose, take it as soon as you remember, but skip it if it’s almost time for your next dose. Never double up on doses.

Metoclopramide Side Effects and Adverse Reactions

Like all medications, Metoclopramide can cause side effects. Some are more common, while others are rare but serious. If you experience any of these side effects, contact your healthcare provider immediately. You can also schedule a telemedicine consultation with one of our providers for further evaluation.

Common Side Effects: Drowsiness, fatigue, restlessness, and diarrhea. These are usually mild and may subside as your body adjusts to the medication.

Less Common Side Effects: Dizziness, headache, and difficulty sleeping.

Serious Side Effects: Uncontrolled muscle movements (tardive dyskinesia), depression, and severe allergic reactions. These require immediate medical attention.

Contraindications for Metoclopramide

A contraindication is a specific situation or condition where a particular medication should not be used because it may cause harm. If you have any of the conditions listed below, taking Metoclopramide could be unsafe for you. Always consult with your healthcare provider before starting any new medication, or speak with one of our telemedicine providers right away.

Gastrointestinal (GI) bleeding, perforation, or obstruction: Metoclopramide stimulates movement in the digestive tract, which could worsen these conditions and lead to serious complications.

Pheochromocytoma: This is a rare tumor of the adrenal glands that can cause high blood pressure. Metoclopramide may increase the risk of dangerously high blood pressure in patients with this condition.

Seizure disorders: Metoclopramide can lower the seizure threshold, meaning it could make seizures more likely or more severe in people with epilepsy or other seizure disorders.

Parkinson’s disease: Metoclopramide affects dopamine, a brain chemical that is already low in people with Parkinson’s. Taking this medication could worsen symptoms of Parkinson’s disease.

History of tardive dyskinesia: Tardive dyskinesia is a disorder that causes involuntary, repetitive movements. Metoclopramide can increase the risk of developing this condition, especially with long-term use.

Drug to Drug Interactions

Metoclopramide can interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. It’s important to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Some known Metoclopramide interactions include:

1. Antipsychotics: Medications such as haloperidol (Haldol) and chlorpromazine (Thorazine) can increase the risk of movement disorders when used with Metoclopramide.
2. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft) may heighten the risk of serotonin syndrome when combined with Metoclopramide.
3. MAO inhibitors: Drugs such as phenelzine (Nardil) and tranylcypromine (Parnate) can raise the risk of high blood pressure when taken with Metoclopramide.
4. Opioids: Medications like oxycodone (OxyContin) and hydrocodone (Vicodin) can slow digestion, which may counteract Metoclopramide’s effects.
5. Anticholinergics: Drugs such as diphenhydramine (Benadryl) and oxybutynin (Ditropan) may reduce Metoclopramide’s effectiveness by slowing down gut movement.

Metoclopramide in Pregnancy

Is it Safe to Take Metoclopramide During Pregnancy?

Metoclopramide is classified as a Category B medication for pregnancy by the FDA, meaning animal studies have not shown harm to the fetus, but there are not enough well-controlled studies in pregnant women. It is sometimes prescribed to treat nausea and vomiting during pregnancy, particularly when other treatments have not been effective. However, always consult your healthcare provider before taking Metoclopramide during pregnancy to carefully weigh the potential benefits and risks.

Metoclopramide While Breastfeeding

Is it Safe to Take Metoclopramide While Breastfeeding?

Metoclopramide passes into breast milk in small amounts. Some studies suggest it may help increase milk production, but there is a potential risk of side effects in the breastfeeding infant, such as irritability or digestive issues. If you are breastfeeding, it’s essential to discuss the risks and benefits with your healthcare provider before taking Metoclopramide while breastfeeding.

Estimated Cost of Metoclopramide

The cost of a 30-day supply of Metoclopramide without insurance can vary depending on the pharmacy and location. With a GoodRX coupon, the estimated cost for a 30-day supply of Metoclopramide (10 mg tablets) ranges from approximately $10 to $15. For the most accurate pricing, check with your local pharmacy.

Possible Alternatives to Metoclopramide

If Metoclopramide is not suitable for you, or if you are exploring alternative treatments, there are other options available for the conditions it treats. Always consult your healthcare provider before making any changes to your treatment plan, or speak with one of our telemedicine providers for personalized advice.

1. Nausea and Vomiting: Alternatives include ondansetron (Zofran), ginger supplements, or lifestyle changes such as eating smaller, more frequent meals and avoiding strong odors.
2. Gastroparesis: Alternatives include domperidone (not available in the U.S. but available in some countries), erythromycin, or dietary adjustments like eating low-fat, low-fiber meals.
3. Gastroesophageal Reflux Disease (GERD): Alternatives include proton pump inhibitors (PPIs) like omeprazole (Prilosec), H2 blockers like ranitidine (Zantac), or lifestyle changes such as elevating the head of your bed and avoiding trigger foods.
4. Migraine: Alternatives include triptans like sumatriptan (Imitrex), anti-nausea medications like prochlorperazine (Compazine), or lifestyle changes such as managing stress and avoiding known migraine triggers.
5. Chemotherapy-induced nausea: Alternatives include ondansetron (Zofran), aprepitant (Emend), or non-drug approaches like acupressure or ginger supplements.
6. Postoperative nausea: Alternatives include ondansetron (Zofran), dexamethasone, or non-drug approaches like deep breathing exercises or acupuncture.
7. Diabetic gastroparesis: Alternatives include dietary changes, blood sugar management, and medications like erythromycin or domperidone (if available).
8. Functional dyspepsia: Alternatives include proton pump inhibitors (PPIs), H2 blockers, or lifestyle changes such as reducing stress and avoiding spicy or fatty foods.
9. Intestinal obstruction: This is a medical emergency, and treatment typically involves surgery or other interventions. Medications like Metoclopramide are not appropriate for this condition.

Recent Updates on Metoclopramide Research

Recent research on Metoclopramide has focused on its long-term safety, particularly the risk of tardive dyskinesia, a serious movement disorder. Studies indicate that the risk increases with prolonged use, especially in older adults. As a result, healthcare providers are encouraged to prescribe the lowest effective dose for the shortest duration possible. Additionally, ongoing research into the use of Metoclopramide for nausea and vomiting during pregnancy suggests it may be a safe and effective option when other treatments have failed. However, more research is needed to fully understand the long-term effects on both the mother and baby.

If you have concerns about Metoclopramide uses or would like to discuss your treatment options, our telemedicine providers are available to assist you.

James Kingsley

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