Plasil

# Plasil ## Overview - **Classification**: Dopamine-2 receptor antagonist, antiemetic, prokinetic. - **Mechanism**: Blocks dopamine D2 receptors in the chemoreceptor trigger zone (CTZ) and gastrointestinal tract, enhancing GI motility and reducing nausea/vomiting. ## Primary Indications 1. **Diabetic Gastroparesis** - Symptomatic relief of acute and recurrent diabetic gastroparesis. 2. **Gastroesophageal Reflux Disease (GERD)** - Symptomatic relief when standard therapies are ineffective. 3. **Chemotherapy-Induced Nausea/Vomiting (CINV)** - Prevention/treatment, often adjunctive. 4. **Post-Operative Nausea/Vomiting (PONV)** - Prevention/treatment. 5. **Facilitation of Small Bowel Intubation/Radiology** - To speed passage of contrast/tube. ## Adult Dosing ### Standard Dosing **Diabetic Gastroparesis (symptomatic)** - **Dose**: **10 mg** - **Frequency**: QID (30 min before meals and at bedtime) - **Route**: PO - **Duration**: Short-term (2-8 weeks), max 12 weeks due to TD risk. **Chemotherapy-Induced Nausea/Vomiting (CINV)** - **Dose**: **1-2 mg/kg** - **Frequency**: Q2-4H for 2-5 doses - **Route**: IV (infused slowly over 15-30 min) - **Special Considerations**: Often used with other antiemetics. **Post-Operative Nausea/Vomiting (PONV)** - **Dose**: **10 mg** - **Frequency**: Single dose or Q6-8H PRN - **Route**: IV/IM **Symptomatic GERD (when other therapies fail)** - **Dose**: **10 mg** - **Frequency**: Up to QID (30 min before meals and at bedtime) - **Route**: PO - **Duration**: Short-term (4-12 weeks). **Facilitation of Small Bowel Intubation / Radiological Exam** - **Dose**: **10 mg** - **Frequency**: Single dose, 5-10 minutes prior to procedure - **Route**: IV (over 1-2 min) ### Dose Adjustments - **Renal Impairment**: - CrCl 10-40 mL/min: Reduce dose by 50%. - CrCl <10 mL/min: Reduce dose by 75%. Not recommended for long-term use. - **Hepatic Impairment**: No specific dose adjustment but use with caution in severe impairment. - **Elderly Patients**: Start at lower doses (**5 mg**) due to increased risk of extrapyramidal symptoms (EPS) and decreased renal function. Max duration is generally 3 months. ## Pediatric Dosing **General for Nausea/Vomiting, Gastroparesis, Small Bowel Intubation** - **Route**: PO or IV (IV infused slowly over 15-30 min). ### Neonates (0-28 days) - **Dose**: **0.1 mg/kg/dose** - **Frequency**: Q6-8H - **Maximum**: **0.1 mg/kg/dose** - **Special Notes**: Use with extreme caution. Not routinely recommended due to high risk of EPS. ### Infants (1-12 months) - **Dose**: **0.1-0.15 mg/kg/dose** - **Frequency**: Q6-8H - **Maximum**: **0.5 mg/kg/day** (total daily dose). ### Children (1-12 years) - **Dose**: **0.1-0.15 mg/kg/dose** - **Frequency**: Q6-8H - **Maximum**: **10 mg/dose** or **0.5 mg/kg/day** (whichever is less). Max daily dose **40 mg**. ### Adolescents (13-18 years) - **Dose**: Use adult dosing, typically **10 mg/dose**. - **Frequency**: Up to QID. - **Maximum**: **40 mg/day**. ## Safety Information ### Contraindications - **Absolute**: GI hemorrhage, obstruction, or perforation (exacerbates condition). - **Absolute**: Pheochromocytoma (risk of hypertensive crisis). - **Absolute**: History of seizure disorder (lowers seizure threshold). - **Absolute**: History of tardive dyskinesia (TD) from metoclopramide or neuroleptics. - **Absolute**: Parkinson's disease (worsens symptoms). - **Absolute**: Known hypersensitivity. ### Common Adverse Effects - **Very Common (>10%)**: Sedation, fatigue, drowsiness, restlessness. - **Common (1-10%)**: Headache, dizziness, diarrhea, anxiety, insomnia. - **Serious but Rare**: Extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism), Tardive Dyskinesia (TD), Neuroleptic Malignant Syndrome (NMS), depression with suicidal ideation, prolonged QT interval. ### Key Drug Interactions - **Dopamine Agonists (e.g., Levodopa)**: Metoclopramide antagonizes effects; avoid co-administration. - **Anticholinergics/Opioids**: Antagonize metoclopramide's prokinetic effects; avoid if motility is desired. - **CNS Depressants (e.g., alcohol, benzodiazepines)**: Enhanced sedative effects; use with caution. - **Antipsychotics**: Increased risk of EPS and NMS; use with extreme caution or avoid. - **SSRIs/MAOIs**: Risk of serotonin syndrome; monitor closely. ## Monitoring & Follow-up - **Before Treatment**: Assess for GI obstruction, seizure history, Parkinson's disease, pheochromocytoma. - **During Treatment**: Monitor for CNS effects (sedation, agitation), involuntary movements (EPS, TD). - **Clinical Signs**: Watch for stiff muscles, fever, altered mental status (NMS), or any uncontrolled body movements. ## Clinical Pearls - 💡 **Tip 1**: Limit treatment duration to **<12 weeks** in adults due to the risk of irreversible tardive dyskinesia, especially in the elderly. - 💡 **Tip 2**: Administer IV doses slowly (**over 15-30 minutes**) to reduce the risk of acute dystonic reactions. - 💡 **Tip 3**: Counsel patients on potential for drowsiness and avoiding alcohol. Report any unusual muscle movements immediately. - 💡 **Tip 4**: Not recommended for routine use in children <1 year of age due to increased risk of EPS. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.