Metoclopramide
Mechanism :
Acts as an antiemetic by blocking dopamine receptors and also blocks serotonin receptors in chemoreceptor trigger zone of the CNS.
Promotes GI motility by enhancing the response to acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions & increases lower esophageal sphincter tone.
Indication :
- Gastroesophageal Reflux Disease
- Nausea/Vomiting
Contraindications :
Hypersensitivity to metoclopramide or any component of the formulation; situations where stimulation of gastrointestinal motility may be dangerous, including mechanical GI obstruction, perforation, or haemorrhage; pheochromocytoma or other catecholamine-releasing paragangliomas; seizure disorder; history of tardive dyskinesia or dystonic reaction to metoclopramide; concomitant use with other agents likely to increase extrapyramidal reactions, Infants <1 year of age.
Dosing :
Give 30 min before meals.
Neonate:
0.15 mg/kg IV every 6 hours.
Infants:
0.1 mg/kg IV/IM/PO every 6-8 hours. Max dose: 0.3-0.75 mg/kg/day.
Adverse Effect :
Extrapyramidal symptoms- dystonic reactions inclusive of oculogyric crisis, diarrhea, drowsiness, fatigue, headache, somnolence, dizziness and restlessness.
Less common or rare: Breast tenderness with swelling, increased breast milk, changes in menstruation seen in females, decreased interest in sexual intercourse, increased frequency of urine, constipation, mental depression, skin rash, Neuroleptic malignant syndrome.
Interaction :
Anticholinergic Agents: May diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Anti-Parkinson Agents (Dopamine Agonist): Metoclopramide may diminish the therapeutic effect of Anti-Parkinson Agents.
Antipsychotic Agents: Metoclopramide may enhance the adverse/toxic effect of Antipsychotic Agents.
Atovaquone: Metoclopramide may decrease the serum concentration of Atovaquone.
Selective Serotonin Reuptake Inhibitors: Metoclopramide may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.
Tricyclic Antidepressants: Metoclopramide may enhance the adverse/toxic effect of Tricyclic Antidepressants.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Dialysed. Dose as in normal renal function |
| HDF/High flux | Dialysed. Dose as in normal renal function |
| CAV/VVHD | Dialysed. Dose as in normal renal function |
Hepatic Dose :
Severe hepatic impairment: Reduce the dose by 50%. Risk-benefit should be carefully considered in patients with significant hepatic impairment due to loss of conjugation and increased risk of extrapyramidal effects.