Trade name(s): Metoclopramide followed by brand that makes it Drug Class: Antiemetic
Theraputic use: mainly used as an antiemetic and to accelerate upper GI tract mobility. Lessens nausea and vomiting.
Pharmacological action: stimulates upper GI tract mobility without increasing secretions. how it does this is obscure but may be related to making tissues more attentive to Ach. Effects are not reliant on vagal innervation yet can be counteracted by anticholinergic meds (interesting IMO).
Pharmacokinetics:
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Absorption: Onset of action is around 1-3 minutes in IV injection and 10-15 in IM injection. Effect lasts 1-2 hours
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Distribution: Protein binding is 13-22%
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Metabolism: Metabolism mostly occurs in the liver and elimination half‐life is from 2.5 to 6 hours.
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Excretion: ~80% of the drug is found in urine in the first 24 hours.
Around half is metoclopramide and half is the glucuronide conjugate + sulphate conjugate.
Indications: Nausea and vomiting (IN INDIVIDUALS UNDER 20 YEARS SEE NOTE), gastrointestinal radiology or duodenal intubation. intractible hiccups in palliative care
Individuals under 20 years SHOULD ONLY indicated for in the following cases
- severe intractable vomiting of known cause
- vomiting due to radiotherapy or cytotoxic drugs
- aid to gastro-intestinal intubation
- premedication prior to surgical procedures.
Contraindications: GI obstruction, perforation, or haemorrhage, history of neuroleptic malignant syndrome or metoclopramide induced extrapyramidal adverse effects, Parkinson’s disease, pheochromocytoma, epilepsy.
Precautions: Elderly have higher risk of tardive dyskinesia (PERMANENT in some cases). Young adults and children have higher risk of dystonic reactions. GI surgery, HTN, cardiac conduction disturbances, may mask underlying disorders such as cerebral irritation, depression, prolactin dependant breast cancer
Adverse reactions: Occurs in ~10 percent of patients: restlessness, drowsiness, fatigue and lethargy. tardive dyskinesia which can be irreversible. rarely depression (and suicidal ideation and suicide).
Dystonic reactions can occur in around 1% of patients and moreso in young adults and children with high doses. these can go away on ending of treatment.
Interactions: apomorphine, atovaquone, bromocriptine, ciclosporin, thought to decrease effects of general antiparkinsons.
Dosing/Current guidelines: Dose dependant on route of admin:
Nausea and vomiting Oral, IV (minimum 3min duration), IM injection
- Adult 60 kg and over: 10mg 3 times daily for max 5 days
- Adult under 60 kg: 5 mg 3x daily for max 5 days
Gastrointestinal radiology or duodenal intubation Oral, IV (minimum 3min duration), IM injection
- Adult: over 20. 10-20 mg 5-10 mins before procedure
- Adult: under 20. 10 mg 5-10 mins before procedure
Nausea and vomiting in palliative care Oral, SC injection (unapproved)
- Adult: 10 mg 3–4x daily
Continuous SC infusion (unapproved)
- Adult: 30–100 mg over 24h
Intractable hiccups in palliative care Oral, SC injection
- Adult: 10 mg every 6–8h
Monitoring: Monitor for extrapyramidal symptoms including dystonic reactions and tardive dyskinesia during treatment.
Overdose: Extrapyramidal side effects are the most frequently repoared ADRS to overdosage. very rarely AV has been observed.
Treatment of OD: Supportive care and close observation is reccomended. antiparkinson and antihistamine/antocholinergic have been known to control extrapyramidal reacitotns. haemodialysis appears ineffective in removing metoclopramide,
Pregnancy: generally compatible.
What to tell patients: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol.
*Give the patients the associated consumer info sheet*
Injection and tablets subsidised by PHARMAC
Comments/Observations/notes: crazy antiemetic imo.