Metoclopramide

PHARMACOLOGY

Acts as a combined dopamine-receptor antagonist and 5HT4-receptor agonist. It has prokinetic properties. It is used for nausea and vomiting. It can be given PO, SC or IV

Onset of action: 10-15 minutes SC; 15-60 minutes PO
Duration of action: 1 to 2 h (sometimes longer)
Plasma ½ life: 2.5-5 h

DOSING

  • 5-10-20 mg PO/SC tid-qid at meals
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  • 0.1 to 0.2 mg/kg/dose q6h PO/SC/IV

UNWANTED EFFECTS

  • Extrapyramidal side effects
    • Acute dystonias
    • Pseudoparkinsonism
    • Akathisia (restlessness)
  • Drowsiness
  • Depression
  • Diarrhoea

PITFALLS/CONCERNS

  • Serious drug interactions exist
  • Avoid concurrent use with antimuscarinics which block the action of prokinetics such as metoclopramide
  • Used most commonly for nausea and vomiting due to gastric stasis because of its prokinetic properties

NOTE

This information is drawn from a number of sources (see below). The reader is encouraged to access these and other relevant literature for more detail. As always, sound clinical judgment should be used in individual clinical cases. In particular, it should be remembered that there may be significant variation in the pharmokinetics of a drug resulting from a number of factors, including the individual patient’s metabolism/disease status and how the medication has been formulated.

SOURCES/REFERENCES

  1. Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s: the pharmacological basis of therapeutics. 11th ed. McGraw-Hill Professional; 2006.
  2. Twycross R, Wilcock A. Palliative care formulary. 3rd ed. Radcliffe Medical Press Ltd; 2008.
  3. Repchinsky C, editor. Compendium of pharmaceuticals and specialties (CPS): the Canadian drug reference for health professionals. 44th ed. Canadian Pharmacists Association; 2009.
  4. Goldman A, Hain R, Liben S. Oxford textbook of palliative care for children. 1st ed. Oxford University Press; 2006.

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