Metoclopramide: Difference between revisions

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==General==
==General==
*Type: anti-emetic
*Type: [[antiemetics]]
*Dosage Forms: 5, 10; 5/5 mL; IM; IV
*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
===[[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
===[[Diabetic gastroparesis]]===
*10mg PO/IM/IV qac and qhs
*Max: x12wk


'''nausea/vomiting prevention, chemo-related''': 1-2 mg/kg IV q2-3h
===[[Nausea/vomiting]] prevention, chemo-related===
*1-2mg/kg IV q2-3h


'''nausea/vomiting prevention, postop''': 10mg IM/IV x 1
===[[Nausea/vomiting]] prevention, postop===
*10mg IM/IV x 1


'''small bowel intubation''': 10mg IV x 1  
===small bowel intubation===
*10mg IV x 1  


'''radiologic exam''': 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
===Palliative medicine===
*10mg subcutaneously or orally 6-hourly and/or 30mg via [[CSCI]] over 24 hours


==Pediatric Dosing==
==Pediatric Dosing==
'''GERD''': 0.1-0.2 mg/kg PO/IM/IV qid, Max: 0.8mg/kg/24h x 12wk
===GERD===
*0.1-0.2mg/kg PO/IM/IV QID
*Max: 0.8mg/kg/24h x 12wk


'''nausea/vomiting prevention, chemo-related''': 1-2 mg/kg IV q2-4h
===[[Nausea and vomiting (peds)|Nausea/vomiting]] prevention, chemo-related===
*1-2mg/kg IV q2-4h


'''nausea/vomiting prevention, postop''': 0.1-0.2 mg/kg IV x1
===[[Nausea and vomiting (peds)|Nausea/vomiting]] prevention, postop===
*0.1-0.2mg/kg IV x1


==Special Populations==
==Special Populations==
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*caution if Parkinson disease
*caution if Parkinson disease
*caution if NADH methemoglobin reductase deficiency
*caution if NADH methemoglobin reductase deficiency
*caution if HTN
*caution if hypertension
*caution if CHF
*caution if CHF
*caution if cirrhosis
*caution if cirrhosis
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*parkinsonism
*parkinsonism
*tardive dyskinesia
*tardive dyskinesia
*neuroleptic malignant syndrome
*[[neuroleptic malignant syndrome]]
*seizures
*seizures
*depression
*depression
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*agranulocytosis
*agranulocytosis
*methemoglobinemia
*methemoglobinemia
*CHF, acute
*[[CHF]], acute
*AV block
*AV block
*SVT
*SVT
*HTN
*hypertension
*angioedema
*angioedema
*hepatotoxicity
*hepatotoxicity
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*fluid retention
*fluid retention
*hypotension
*hypotension
*HTN
*hypertension
*bradycardia
*bradycardia
*nausea
*nausea
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<references/>
<references/>
[[Category:Pharmacology]]
[[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

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

GERD

  • 0.1-0.2mg/kg PO/IM/IV QID
  • Max: 0.8mg/kg/24h x 12wk

Nausea/vomiting prevention, chemo-related

  • 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

Comments

See Also

References

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