Metoclopamide

# Metoclopamide ## Overview A prokinetic agent and antiemetic; a dopamine D2 receptor antagonist, also sensitizes the gut to acetylcholine. Used for nausea/vomiting and gastroparesis. Risk of tardive dyskinesia limits long-term use. ## Primary Indications - Gastroparesis (diabetic, idiopathic) - Chemotherapy-induced nausea/vomiting (CINV) (less common now due to better alternatives) - Postoperative nausea/vomiting (PONV) - Other nausea/vomiting where indicated ## Adult Dosing - **Gastroparesis**: 5–10 mg PO 30 minutes before meals and at bedtime; max 40 mg/day. - **IV/IM antiemetic**: 10 mg IV/IM every 6–8 hours as needed. - **PONV**: 10–20 mg IV at end of surgery (single dose; 20 mg max). ## Pediatric Dosing - **Age ≥1 year**: 0.1–0.2 mg/kg/dose PO/IV/IM; max single dose 10 mg. Frequency: every 6–8 hours. Max daily dose: 0.5 mg/kg/day. **Note**: Exact dosing depends on local protocol; risk of extrapyramidal symptoms (EPS) is higher in children. ## Dose Adjustments - **Renal impairment**: CrCl <40 mL/min: reduce dose by 50%; CrCl <10 mL/min: use with caution. - **Hepatic impairment**: Severe: dose reduction recommended; consult local protocol. ## Contraindications - Suspected or confirmed pheochromocytoma - History of tardive dyskinesia (from metoclopamide or other drugs) - GI obstruction, perforation, or hemorrhage - Epilepsy (lowers seizure threshold) ## Adverse Effects - **Common**: Drowsiness, restlessness, fatigue, diarrhea - **Serious**: Tardive dyskinesia (risk increases with duration >12 weeks), EPS (acute dystonia, akathisia), neuroleptic malignant syndrome, QT prolongation ## Key Drug Interactions - **Anticholinergics** (e.g., atropine, benztropine): antagonize prokinetic effect - **CNS depressants** (alcohol, opioids, sedatives): additive sedation - **MAOIs**: risk of hypertensive crisis - **SSRIs/SNRIs**: increased EPS risk - **Digoxin, cyclosporine**: decreased absorption due to rapid GI transit ## Monitoring - Baseline and periodic assessment for EPS (especially in children and elderly) - Renal function (for dose adjustment) - Signs of tardive dyskinesia with long-term use (>12 weeks) - QT interval if high-risk patient or IV use ## Clinical Pearls - **Short-term use only**: <12 weeks cumulative to minimize tardive dyskinesia risk. For gastroparesis, reassess need regularly. - **EPS treatment**: Acute dystonia (e.g., oculogyric crisis) can be reversed with diphenhydramine 25–50 mg IM/IV (adult) or benztropine. - **Alternatives**: Domperidone (if available) or erythromycin as prokinetic for gastroparesis with lower CNS risk. - **IV administration**: Give over 1–2 minutes to reduce risk of hypotension. --- *Disclaimer: This information is for educational purposes and does not replace clinical judgment. Always verify current prescribing information from authoritative sources (e.g., manufacturer's label, updated clinical guidelines) before use.*