From the Guidelines
The maximum dose of metoclopramide (Reglan) for adults is 10 mg IV or orally, with a typical dosing frequency of 20 to 30 minutes before or with a simple analgesic, NSAID, or ergotamine derivative. When considering the use of metoclopramide, it's essential to weigh the benefits against the potential risks, particularly the risk of tardive dyskinesia, a potentially irreversible movement disorder, which is more likely with prolonged use 1. The medication is often used to treat accompanying nausea and improve gastric motility, which may be impaired during migraine attacks, and its efficacy is rated as 2 on a scale of 1 to 4, with 4 being most effective 1. Some key points to consider when prescribing metoclopramide 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
- The importance of limiting treatment duration to minimize the risk of tardive dyskinesia, with a general recommendation not to exceed 12 weeks 1. Given the potential risks and side effects, it's crucial to use the lowest effective dose and monitor patients closely, especially elderly patients and those with kidney impairment, who may require lower doses 1.
From the Research
Recommended Dosage of Metoclopramide for Adults
The recommended dosage of metoclopramide (Reglan) for adults is:
- 10 mg 3-4 times daily, as regulatory authorities have issued restrictions and recommendations regarding long-term use of the drug at oral doses exceeding this amount due to the risk of developing tardive dyskinesia 2
Important Considerations
- High-risk groups for tardive dyskinesia include elderly females, diabetics, patients with liver or kidney failure, and patients with concomitant antipsychotic drug therapy 2, 3
- The risk of tardive dyskinesia from metoclopramide is low, in the range of 0.1% per 1000 patient years 2
- Metoclopramide can lead to extrapyramidal side effects such as tardive dyskinesia due to its mechanism of action as a dopamine D2-receptor blocking agent 4
Additional Information
- The FDA issued a black box warning regarding long-term or high-dose use of metoclopramide because of the risk of developing tardive dyskinesia 3
- Available data show that the risk of tardive dyskinesia from metoclopramide use is likely to be <1%, much less than the estimated 1-10% risk previously suggested in national guidelines 3