Metoclopramide (Reglan)

Category:

  • Gastrointestinal

Description:

  • Prokinetic agent; antiemetic

Indications:

  • Gastroesophageal reflux disease (GERD)

  • Diabetic gastroparesis

  • Facilitation of small bowel intubation

  • Not FDA approved: *slow bowel emptying, gastric stasis in preterm infants, drug-related postoperative nausea and vomiting

Contraindications:

  • Gastrointestinal hemorrhage, mechanical obstruction, or perforation of the GI tract

  • Pheochromocytoma

  • Seizure disorders

Precautions:

  • Pregnancy category B; may use during pregnancy as an antiemetic

  • Avoid use during breast feeding; potent CNS effects possible

Adverse Reactions (Side Effects):

  • CNS: dizziness, drowsiness, EPS (tardive dyskinesia, akathisisa, parkinson-like symptoms, dystonia), fatigue, hallucinations, seizures, sedation, restlessness, headache

  • CV: bradycardia, hypertension, hypotension, supraventricular arrythmias

  • EENT: visual disturbances

  • GI: bowel disturbances, diarrhea, nausea

  • GU: incontinence, urinary frequency

  • HEME: agranulocytosis, leukopenia, methemoglobinemia, neutropenia, porphyria

  • METAB: amenorrhea, elevated aldosterone, gtalactorrhea, gynecomastia, impotence (hyperporlactinemia)

  • SKIN: rash, urticaria

  • MISC: neuroleptic malignant syndrome

Dosage:

Administered orally (tablets,syrup), IM, and IV

  • Adult: 

    • Gastroparesis/GERD: 

      • PO/IM/IV 10-15mg 30 minutes before meals and bedtime

      • PR 25mg (5 tablets compounded in polyethylene glycol) 30 minutes before meals and at bedtime.

  • Child: 

    • GERD: 

      • PO/IM/IV 0.4-0.8mg/kg/day divided into 4 doses.

    • Intubation small bowel: 

      • IV (<age 6) 0.1mg/kg; (age 6-14) 2.5-5mg

  • Renal failure adjustment: 

    • CrCl 10-50 ml/min administer 75% of recommended dose

    • CrCl <10 ml/min admister 25-50% of recommended dose

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