Metoclopramide

(Redirected from Reglan)

General

  • Type: anti-emetic
  • Dosage Forms: 5, 10; 5/5 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

Authors:

Ross Donaldson