What is the recommended dose and frequency of Metoclopramide (Reglan)?

From the Guidelines

Reglan (metoclopramide) should be prescribed at a dose of 10 mg IV or orally 20 to 30 minutes before or with a simple analgesic, NSAID, or ergotamine derivative, as adjunctive therapy for migraine treatment, particularly for accompanying nausea and impaired gastric motility 1. The dosage and frequency of Reglan can vary depending on the specific condition being treated, but for migraine, the recommended dose is 10 mg, which can be administered orally or intravenously.

• Key considerations for Reglan use include:
  • Contraindications such as pheochromocytoma, seizure disorder, GI bleeding, and GI obstruction 1
  • Potential adverse reactions like restlessness, drowsiness, diarrhea, muscle weakness, and dystonic reaction 1
  • Efficacy rating of 2, indicating moderate effectiveness as an adjunctive therapy for migraine 1 The primary use of Reglan in migraine treatment is to address nausea and improve gastric motility, which may be impaired during migraine attacks, rather than as a primary analgesic 1.
• Important factors to consider when prescribing Reglan for migraine include:
  • Limiting use to the recommended dose and duration to minimize the risk of adverse effects
  • Monitoring patients for potential side effects, particularly extrapyramidal symptoms
  • Using Reglan as part of a comprehensive treatment plan that may include other medications for migraine pain and associated symptoms 1.

From the FDA Drug Label

For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated.

For the Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy Intravenous infusions should be made slowly over a period of not less than 15 minutes, 30 minutes before beginning cancer chemotherapy and repeated every 2 hours for two doses, then every 3 hours for three doses

For the Prevention of Postoperative Nausea and Vomiting Metoclopramide Injection, USP should be given intramuscularly near the end of surgery. The usual adult dose is 10 mg; however, doses of 20 mg may be used

To Facilitate Small Bowel Intubation The recommended single dose is: Pediatric patients above 14 years of age and adults – 10 mg metoclopramide base.

The recommended dose and frequency of Reglan (metoclopramide) varies depending on the indication:

• For diabetic gastroparesis, the dose is not specified, but oral administration may be initiated.
• For prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, the dose is 1-2 mg/kg, administered every 2 hours for two doses, then every 3 hours for three doses.
• For prevention of postoperative nausea and vomiting, the usual adult dose is 10 mg, administered intramuscularly near the end of surgery.
• To facilitate small bowel intubation, the recommended single dose is 10 mg for adults and pediatric patients above 14 years of age 2.

From the Research

Reglan Dose and Frequency

• The provided studies do not directly mention the dose and frequency of Reglan (metoclopramide) in detail, but they do provide some information about its usage and effects in various contexts.
• In the study 3, metoclopramide was administered at a dose of 10mg orally to term pregnant women scheduled for elective cesarean delivery.
• The study 4 mentions that metoclopramide was used in various studies to treat gastroparesis, but it does not provide specific information about the dose and frequency.
• The study 5 discusses the adverse events associated with metoclopramide and domperidone in the treatment of gastroparesis, but it does not provide detailed information about the dose and frequency of metoclopramide.
• The study 6 reviews the use of prokinetic agents, including metoclopramide, in the treatment of gastro-oesophageal reflux disease, but it does not provide specific information about the dose and frequency of metoclopramide.

Comparison with Other Prokinetic Agents

• The study 4 compares the effects of different prokinetic agents, including metoclopramide, domperidone, cisapride, and erythromycin, on gastric emptying and symptoms in patients with gastroparesis.
• The study 7 describes the use of erythromycin as a prokinetic agent in patients with terminal illness and small bowel obstruction, and suggests that it may be a viable alternative to metoclopramide and domperidone.
• The study 3 compares the effects of erythromycin and metoclopramide on gastric emptying in term pregnant women scheduled for elective cesarean delivery, and finds that both agents accelerate gastric emptying and may reduce aspiration risk.