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