Formulary
Metoclopramide hydrochloride: Indications, Dosing, Side Effects and Interactions
Metoclopramide hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Metoclopramide hydrochloride: Indications, Dosing, Side Effects and Interactions
Metoclopramide hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Symptomatic treatment of nausea and vomiting including that associated with acute migraine,Prevention of delayed (but not acute) chemotherapy-induced nausea and vomiting,Prevention of radiotherapy-induced nausea and vomiting,Prevention of postoperative nausea and vomiting**
- **Adult** (By Mouth, Or By Intramuscular Injection, Or By Slow Intravenous Injection): (body-weight 60 kg and above) 10 mg up to 3 times a day for a maximum of 5 days.
**Hiccup in palliative care**
- **Adult** (By Mouth, Or By Intramuscular Injection, Or By Subcutaneous Injection): 10 mg every 6-8 hours.
**Nausea and vomiting in palliative care**
- **Adult** (By Mouth): 30-100 mg/24 hours.
**Acute migraine**
- **Adult** (By Mouth, Or By Slow Intravenous Injection, Or By Intramuscular Injection): 10 mg for 1 dose, to be administered as soon as migraine symptoms develop.
**Second-line option for treatment of established postoperative nausea and vomiting for metoclopramide hydrochloride**
- **Child 1-17 years** (By mouth, or by intramuscular injection, or by slow intravenous injection): 100-150 micrograms/kg up to 3 times a day (max. per dose 10 mg) for a maximum of 48 hours.
**Second-line option for prevention of delayed chemotherapy-induced nausea and vomiting for metoclopramide hydrochloride**
- **Child 1-17 years** (By mouth, or by intramuscular injection, or by slow intravenous injection): 100-150 micrograms/kg up to 3 times a day (max. per dose 10 mg) for a maximum of 5 days.
Cautions
Asthma; atopic allergy; bradycardia; cardiac conduction disturbances; children; elderly; may mask underlying disorders such as cerebral irritation; Parkinson's disease; uncorrected electrolyte imbalance; young adults Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in patients with parkinsonism (risk of exacerbating parkinsonian symptoms).
Contraindications
For metoclopramide hydrochloride 3-4 days after gastrointestinal surgery; epilepsy; gastro-intestinal haemorrhage; gastro-intestinal obstruction; gastro-intestinal perforation; phaeochromocytoma
Side effects
General side-effects: Common or very common Asthenia; depression; diarrhoea; drowsiness; hypotension; menstrual cycle irregularities; movement disorders; parkinsonism Uncommon Arrhythmias; hallucination; hyperprolactinaemia; level of consciousness decreased Rare or very rare Confusion; galactorrhoea; seizure Frequency not known Atrioventricular block; blood disorders; cardiac arrest; gynaecomastia; hypertension; neuroleptic malignant syndrome (discontinue-potentially fatal); QT interval prolongation; shock; syncope; tremor Specific side-effects: Frequency not known With parenteral use Anxiety; dizziness; dyspnoea; oedema; skin reactions; visual impairment Side-effects, further information Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young (especially girls and young women) and the very old; they usually occur shortly after starting treatment with metoclopramide and subside within 24 hours of stopping it. Injection of an antiparkinsonian drug such as procyclidine will abort dystonic attacks.
Interactions
**Other interactions (9):**
- Combination to be avoided Alcohol potentiates the sedative effect of metoclopramide.
- Anticholinergics and morphine derivatives Anticholinergics and morphine derivatives may have both a mutual antagonism with metoclopramide on the digestive tract motility.
- Central nervous system depressants (morphine derivatives, anxiolytics, sedative H1 antihistamines,sedative antidepressants, barbiturates, clonidine and related) Sedative effects of Central Nervous...
- Digoxin Metoclopramide may decrease digoxin bioavailability.
- Careful monitoring of digoxin plasma concentration is required.
- Cyclosporine Metoclopramide increases cyclosporine bioavailability (Cmax by 46% and exposure by 22%).
Pregnancy
Not known to be harmful.
Breast feeding
Small amount present in milk; avoid.
Hepatic impairment
Manufacturer advises caution in severe impairment (risk of accumulation). Dose adjustments Manufacturer advises dose reduction of 50% in severe impairment.
Renal impairment
Dose adjustments Reduce daily dose by 75% in end-stage renal disease. M Reduce dose by 50% in moderate to severe impairment. M
Medicinal forms
Solution,Tablet,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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