From the Guidelines
Reglan (metoclopramide) should be avoided in patients with chronic kidney disease stage 4 (CKD 4) due to the increased risk of neurological side effects and decreased drug clearance 1. When considering the management of patients with CKD 4, it is essential to prioritize their morbidity, mortality, and quality of life.
- The primary concern with using Reglan in CKD 4 patients is the increased risk of neurological side effects, including extrapyramidal symptoms and tardive dyskinesia, which can significantly impact their quality of life.
- According to the provided evidence, metoclopramide and antidopaminergic drugs should be recommended for treatment of opioid-related nausea/vomiting 1, but this does not necessarily apply to CKD 4 patients.
- In patients with renal impairment, all opioids should be used with caution and at reduced doses and frequency 1, and similarly, metoclopramide should be used with caution due to its renal elimination.
- Alternative medications with less renal elimination might be considered if appropriate for the patient's condition, as the benefit of metoclopramide for treating gastroparesis or GERD symptoms must be carefully weighed against these increased risks in the CKD 4 population.
- Regular monitoring for neurological symptoms is essential, and the medication should be discontinued immediately if such symptoms occur.
- The recommended approach is to prioritize the patient's safety and consider alternative treatment options that do not increase the risk of neurological side effects, as the primary goal is to improve their morbidity, mortality, and quality of life.
From the FDA Drug Label
Use in Patients with Renal or Hepatic Impairment Since metoclopramide is excreted principally through the kidneys, in those patients whose creatinine clearance is below 40 mL/min, therapy should be initiated at approximately one-half the recommended dosage.
Metoclopramide is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function (see DOSAGE & ADMINISTRATION, Use in Patients with Renal or Hepatic Impairment)
The recommended dosage of metoclopramide for patients with CKD 4 (creatinine clearance below 40 mL/min) should be initiated at approximately one-half the recommended dosage 2.
From the Research
Reglan in CKD 4
- Reglan, also known as metoclopramide, is a medication used to treat nausea and vomiting, among other conditions.
- In patients with chronic kidney disease (CKD), the use of metoclopramide may require dose adjustment or avoidance due to the potential for adverse effects 3.
- A study comparing ondansetron with metoclopramide in the symptomatic relief of uremia-induced nausea and vomiting found that ondansetron was more effective than metoclopramide in controlling nausea and vomiting in patients with uremia 4.
- However, there is limited information available on the specific use of Reglan in CKD 4 patients.
- It is essential to consider the potential risks and benefits of using Reglan in patients with CKD 4 and to monitor their kidney function and overall health closely while taking this medication.
- The management of CKD requires a comprehensive approach, including non-pharmacological strategies, such as dietary and lifestyle adjustments, and pharmacological interventions to preserve kidney function and prevent complications 5.
- In general, the use of medications in patients with CKD requires careful consideration of the potential risks and benefits, as well as individualized dose adjustment and monitoring to minimize adverse effects 3, 6, 7.