Metoclopramide: Difference between revisions
Elcatracho (talk | contribs) |
|||
| (24 intermediate revisions by 8 users not shown) | |||
| Line 1: | Line 1: | ||
==General== | ==General== | ||
*Type: | *Type: [[antiemetics]] | ||
*Dosage Forms: | *Dosage Forms: 5mg, 10mg; 5mg/5 mL; IM; IV | ||
*Common Trade Names: Reglan | *Common Trade Names: Reglan | ||
==Adult Dosing== | ==Adult Dosing== | ||
===[[GERD]]=== | |||
*Chronic symptoms: 10-15mg PO/IM/IV qac and qhs | |||
*Max: x12wk; intermittent symptoms: up to 20mg PO/IM/IV x 1 before symptoms | |||
===[[Diabetic gastroparesis]]=== | |||
*10mg PO/IM/IV qac and qhs | |||
*Max: x12wk | |||
===[[Nausea/vomiting]] prevention, chemo-related=== | |||
*1-2mg/kg IV q2-3h | |||
===[[Nausea/vomiting]] prevention, postop=== | |||
*10mg IM/IV x 1 | |||
===small bowel intubation=== | |||
*10mg IV x 1 | |||
===Radiologic exam=== | |||
*10mg IV x 1 | |||
===Palliative medicine=== | |||
*10mg subcutaneously or orally 6-hourly and/or 30mg via [[CSCI]] over 24 hours | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===GERD=== | |||
*0.1-0.2mg/kg PO/IM/IV QID | |||
*Max: 0.8mg/kg/24h x 12wk | |||
===[[Nausea and vomiting (peds)|Nausea/vomiting]] prevention, chemo-related=== | |||
*1-2mg/kg IV q2-4h | |||
===[[Nausea and vomiting (peds)|Nausea/vomiting]] prevention, postop=== | |||
*0.1-0.2mg/kg IV x1 | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | ||
*[[Lactation risk categories|Lactation risk]]: | *[[Lactation risk categories|Lactation risk]]: Safety Unknown | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult: CrCl 41-50: decrease dose 25%; CrCl 10-40: decrease dose 50%; CrCl <10: decrease dose 75%; HD/PD: no supplement | ||
**Pediatric | **Pediatric: CrCl 41-50: decrease dose 25%; CrCl 10-40: decrease dose 50%; CrCl <10: decrease dose 75%; HD/PD: no supplement | ||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult: no adjustment | ||
**Pediatric | **Pediatric: no adjustment | ||
==Contraindications== | ==Contraindications== | ||
| Line 25: | Line 56: | ||
*GI obstruction | *GI obstruction | ||
*caution if depression | *caution if depression | ||
*caution if Parkinson | *caution if Parkinson disease | ||
*caution if NADH methemoglobin reductase deficiency | *caution if NADH methemoglobin reductase deficiency | ||
*caution if | *caution if hypertension | ||
*caution if CHF | *caution if CHF | ||
*caution if cirrhosis | *caution if cirrhosis | ||
| Line 33: | Line 64: | ||
*caution if renal impairment | *caution if renal impairment | ||
*caution if neonates | *caution if neonates | ||
*caution if pediatric | *caution if pediatric patients | ||
*caution if elderly | *caution if elderly patients, esp. female | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*extrapyramidal symptoms | |||
*dystonia, acute | |||
*parkinsonism | |||
*tardive dyskinesia | |||
*[[neuroleptic malignant syndrome]] | |||
*seizures | |||
*depression | |||
*suicidality | |||
*hallucinations | |||
*leukopenia | |||
*neutropenia | |||
*agranulocytosis | |||
*methemoglobinemia | |||
*[[CHF]], acute | |||
*AV block | |||
*SVT | |||
*hypertension | |||
*angioedema | |||
*hepatotoxicity | |||
*withdrawal symptoms if abrupt discontinuation | |||
===Common=== | ===Common=== | ||
*drowsiness | |||
*restlessness | |||
*fatigue | |||
*anxiety | |||
*insomnia | |||
*headache | |||
*confusion | |||
*dizziness | |||
*depression | |||
*extrapyramidal symptoms | |||
*galactorrhea | |||
*amenorrhea | |||
*gynecomastia | |||
*hyperprolactinemia | |||
*impotence | |||
*hyperaldosteronism | |||
*fluid retention | |||
*hypotension | |||
*hypertension | |||
*bradycardia | |||
*nausea | |||
*diarrhea | |||
*urinary frequency | |||
*incontinence | |||
*rash | |||
*urticaria | |||
*visual disturbance | |||
==Pharmacology== | ==Pharmacology== | ||
| Line 53: | Line 131: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:GI]] | |||
Latest revision as of 23:06, 7 March 2021
General
- Type: antiemetics
- Dosage Forms: 5mg, 10mg; 5mg/5 mL; IM; IV
- Common Trade Names: Reglan
Adult Dosing
GERD
- Chronic symptoms: 10-15mg PO/IM/IV qac and qhs
- Max: x12wk; intermittent symptoms: up to 20mg PO/IM/IV x 1 before symptoms
Diabetic gastroparesis
- 10mg PO/IM/IV qac and qhs
- Max: x12wk
- 1-2mg/kg IV q2-3h
Nausea/vomiting prevention, postop
- 10mg IM/IV x 1
small bowel intubation
- 10mg IV x 1
Radiologic exam
- 10mg IV x 1
Palliative medicine
- 10mg subcutaneously or orally 6-hourly and/or 30mg via CSCI over 24 hours
Pediatric Dosing
GERD
- 0.1-0.2mg/kg PO/IM/IV QID
- Max: 0.8mg/kg/24h x 12wk
- 1-2mg/kg IV q2-4h
Nausea/vomiting prevention, postop
- 0.1-0.2mg/kg IV x1
Special Populations
- Pregnancy Rating: B
- Lactation risk: Safety Unknown
- Renal Dosing
- Adult: CrCl 41-50: decrease dose 25%; CrCl 10-40: decrease dose 50%; CrCl <10: decrease dose 75%; HD/PD: no supplement
- Pediatric: CrCl 41-50: decrease dose 25%; CrCl 10-40: decrease dose 50%; CrCl <10: decrease dose 75%; HD/PD: no supplement
- Hepatic Dosing
- Adult: no adjustment
- Pediatric: no adjustment
Contraindications
- Allergy to class/drug
- pheochromocytoma
- seizure disorder
- GI bleeding or perforation
- GI obstruction
- caution if depression
- caution if Parkinson disease
- caution if NADH methemoglobin reductase deficiency
- caution if hypertension
- caution if CHF
- caution if cirrhosis
- caution if dibetes mellitus
- caution if renal impairment
- caution if neonates
- caution if pediatric patients
- caution if elderly patients, esp. female
Adverse Reactions
Serious
- extrapyramidal symptoms
- dystonia, acute
- parkinsonism
- tardive dyskinesia
- neuroleptic malignant syndrome
- seizures
- depression
- suicidality
- hallucinations
- leukopenia
- neutropenia
- agranulocytosis
- methemoglobinemia
- CHF, acute
- AV block
- SVT
- hypertension
- angioedema
- hepatotoxicity
- withdrawal symptoms if abrupt discontinuation
Common
- drowsiness
- restlessness
- fatigue
- anxiety
- insomnia
- headache
- confusion
- dizziness
- depression
- extrapyramidal symptoms
- galactorrhea
- amenorrhea
- gynecomastia
- hyperprolactinemia
- impotence
- hyperaldosteronism
- fluid retention
- hypotension
- hypertension
- bradycardia
- nausea
- diarrhea
- urinary frequency
- incontinence
- rash
- urticaria
- visual disturbance
Pharmacology
- Half-life: 5-6h
- Metabolism: liver minimally; CYP450: unknown
- Excretion: urine 85% (20% unchanged), bile/feces 5%
- Mechanism of Action: exact mechanism of action unknown; sensitizes tissues to acetylcholine, stimulating upper GI tract motility; antagonizes central and peripheral dopamine receptors, producing antiemetic effects