From the Guidelines
Yes, metoclopramide can be given subcutaneously, as this route is considered a viable alternative when oral administration is not possible, according to the European Association for Palliative Care 1. The subcutaneous route is particularly useful in palliative care settings, as noted in the NCCN Clinical Practice Guidelines in Oncology: Palliative Care 1, for managing nausea and vomiting in patients who lack intravenous access or cannot take oral medications.
Administration Details
- The typical subcutaneous dose of metoclopramide is 5-10 mg every 6-8 hours as needed, similar to intravenous dosing.
- It can be administered as intermittent injections or as a continuous subcutaneous infusion, typically at rates of 30-100 mg over 24 hours, depending on the patient's needs.
- When administering subcutaneously, the concentrated formulation (5 mg/mL) should be used to minimize injection volume.
- Common subcutaneous injection sites include the abdomen, upper arms, and thighs.
Mechanism and Side Effects
- Metoclopramide works by blocking dopamine receptors in the chemoreceptor trigger zone and enhancing gastric emptying, making it effective for various causes of nausea.
- The same side effect profile exists regardless of the route, including the risk of extrapyramidal symptoms, especially at higher doses or with prolonged use, as noted in guidelines for managing nausea and vomiting 1.
From the Research
Administration of Metoclopramide
- Metoclopramide can be administered through various routes, including intramuscularly 2, intravenously 3, 4, 5, and subcutaneously 6.
Subcutaneous Administration
- A study published in 1991 investigated the safety and efficacy of short-term subcutaneous administration of metoclopramide in the treatment of symptomatic gastroparesis, and found that it was well accepted by patients and resulted in subjective and objective improvement of gastric stasis 6.
- The study also found that serum metoclopramide concentrations were comparable with other parenteral routes of administration, and that serum prolactin levels may provide both a bioassay of efficacy and a marker for monitoring compliance 6.
Comparison with Other Routes
- A meta-analysis published in 2015 found that continuous intravenous infusion of metoclopramide produced less extrapyramidal side effects than bolus infusion 3.
- Another study published in 1995 found that intravenous granisetron was more effective and produced less adverse effects than multiple doses of metoclopramide in controlling chemotherapy-induced emesis 5.
Efficacy and Safety
- The efficacy and safety of metoclopramide have been compared with other antiemetic agents, such as granisetron, in several studies 2, 4, 5.
- These studies have found that metoclopramide is effective in preventing and treating nausea and vomiting, but may have more side effects, such as extrapyramidal reactions, compared to other agents 2, 4, 5.