What are the effects of Reglan (Metoclopramide) in pregnancy?

From the Guidelines

Reglan (metoclopramide) is a recommended treatment option for hyperemesis gravidarum (HG) in pregnancy, particularly when first-line therapies like vitamin B6 and doxylamine are ineffective, as evidenced by the American College of Obstetricians and Gynecologists (ACOG) guidelines 1.

Key Considerations

• The primary goal in managing HG is to prevent dehydration, correct electrolyte abnormalities, and support adequate maternal and fetal nutrition.
• Metoclopramide has been shown to have similar efficacy to promethazine in hospitalized patients for HG, with fewer adverse events such as drowsiness, dizziness, and dystonia 1.
• No increased risk of congenital defects has been reported with metoclopramide, making it a safer option compared to some other anti-nausea medications.

Treatment Approach

• The recommended dosage of metoclopramide for HG is not explicitly stated in the provided evidence, but typical dosages range from 10 mg orally three to four times daily.
• Treatment should be limited to the shortest duration necessary to minimize the risk of side effects, ideally 12 weeks or less.
• Potential side effects include drowsiness, restlessness, and rarely, extrapyramidal symptoms like involuntary movements, which increase with higher doses and longer treatment durations.

Clinical Decision-Making

• For pregnant women requiring anti-nausea medication, starting with other options like vitamin B6 and doxylamine is typically recommended before progressing to Reglan.
• Any use of Reglan during pregnancy should be monitored by a healthcare provider who can weigh the benefits against potential risks for each individual situation, considering the severity of symptoms and the patient's overall health status.
• Recent guidelines, such as those from the European Association for the Study of the Liver, recommend metoclopramide as a second-line therapy for HG, further supporting its use in pregnancy when necessary 1.

From the FDA Drug Label

Reproduction studies performed in rats, mice, and rabbits by the IM, IV, subcutaneous (SC), and oral routes at maximum levels ranging from 12 to 250 times the human dose have demonstrated no impairment of fertility or significant harm to the fetus due to metoclopramide. There are, however, no adequate and well-controlled studies in pregnant women Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

you are pregnant or plan to become pregnant. It is not known if metoclopramide will harm your unborn child.

Metoclopramide use in pregnancy should be approached with caution. Although animal studies have shown no significant harm to the fetus, there are no adequate and well-controlled studies in pregnant women. Therefore, metoclopramide should only be used during pregnancy if clearly needed 2. It is essential to weigh the potential benefits against the potential risks, and pregnant women should be closely monitored by their healthcare provider. The safety of metoclopramide in human pregnancy has not been established 2.

From the Research

Reglan in Pregnancy

• Reglan, also known as metoclopramide, is a medication used to treat nausea and vomiting in pregnancy.
• According to the study 3, metoclopramide is probably acceptable to use during the second and third trimester of pregnancy.
• The study 4 also mentions that metoclopramide is a first-line treatment for hyperemesis gravidarum, a condition characterized by severe nausea and vomiting in pregnancy.
• The systematic reviews 5, 6, and 7 provide information on the effectiveness and safety of metoclopramide in treating nausea and vomiting in early pregnancy, but do not specifically discuss its use in pregnancy under the brand name Reglan.

Safety of Metoclopramide in Pregnancy

• The studies suggest that metoclopramide is generally considered safe to use during pregnancy, especially during the second and third trimesters.
• However, it is essential to consult a healthcare provider before taking any medication during pregnancy, as they can assess the individual situation and provide personalized advice.
• The studies 4, 5, 6, and 7 provide information on the safety of metoclopramide in pregnancy, but it is crucial to note that the medication should only be used under medical supervision.

Alternative Treatments for Nausea and Vomiting in Pregnancy

• The studies suggest that other medications, such as pyridoxine, prochlorperazine, and ondansetron, may also be effective in treating nausea and vomiting in pregnancy.
• Non-pharmacological interventions, such as acupressure, acupuncture, and dietary changes, may also be beneficial in managing nausea and vomiting in pregnancy, as mentioned in the studies 5, 6, and 7.