What are the uses and dosing guidelines for metoclopramide?

From the Guidelines

Metoclopramide is primarily used to treat nausea, vomiting, and certain gastrointestinal disorders, with a standard adult dosing of 5-20 mg tid-qid, as recommended by the most recent guidelines 1.

Uses of Metoclopramide

• Treatment of nausea and vomiting
• Treatment of gastroparesis, with doses of 5-20 mg tid-qid
• Prevention of chemotherapy-induced nausea

Dosing Guidelines

• Standard adult dosing: 5-20 mg tid-qid
• Maximum recommended daily dose: not explicitly stated, but doses above 10 mg tid not recommended for risk of QT prolongation 1
• Treatment duration should be limited when possible, ideally not exceeding 12 weeks due to the risk of tardive dyskinesia

Important Considerations

• Metoclopramide should be used cautiously in elderly patients, those with renal impairment (requiring dose reduction), and is contraindicated in patients with seizure disorders, pheochromocytoma, or GI obstruction
• Common side effects include drowsiness, restlessness, and fatigue
• Serious adverse effects can include extrapyramidal symptoms and tardive dyskinesia, particularly with prolonged use or higher doses

Evidence-Based Recommendations

• The AGA clinical practice update on management of medically refractory gastroparesis recommends metoclopramide as a treatment option for gastroparesis, with doses of 5-20 mg tid-qid 1
• The ESPEN guidelines on nutrition in cancer patients suggest considering prokinetic agents, such as metoclopramide, to improve early satiety, but with awareness of potential adverse effects 1
• The NCCN clinical practice guidelines in oncology recommend metoclopramide as a treatment option for nausea and vomiting, with doses of 5-10 mg PO QID 30 min before meals and at bedtime 1

From the FDA Drug Label

For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) For the Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy For the Prevention of Postoperative Nausea and Vomiting To Facilitate Small Bowel Intubation To Aid in Radiological Examinations

The uses of metoclopramide include:

• Relief of symptoms associated with diabetic gastroparesis
• Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy
• Prevention of postoperative nausea and vomiting
• Facilitation of small bowel intubation
• Aid in radiological examinations Dosing guidelines vary depending on the specific use and patient population, but typical doses range from 10 mg for adults to 0.1 mg/kg for pediatric patients under 6 years of age 2.

From the Research

Metoclopramide Uses

• Metoclopramide is primarily used as an antiemetic and gastroprokinetic agent 3
• It is used to treat gastroparesis, a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction 4
• Metoclopramide is also used to treat diabetic gastroparesis, which is a common cause of gastroparesis 4
• It acts on several different receptors, primarily as a dopamine receptor antagonist, to improve gastric emptying and provide an anti-emetic effect 4

Dosing Guidelines

• The recommended oral dose of metoclopramide is 10 mg, 3-4 times daily 3
• Regulatory authorities have issued restrictions and recommendations regarding long-term use of the drug at oral doses exceeding 10 mg, 3-4 times daily, due to the risk of developing tardive dyskinesia 3
• The risk of tardive dyskinesia from metoclopramide is low, in the range of 0.1% per 1000 patient years 3
• High-risk groups for tardive dyskinesia include elderly females, diabetics, patients with liver or kidney failure, and patients with concomitant antipsychotic drug therapy 3

Administration Routes

• Metoclopramide can be administered orally, intravenously, or subcutaneously 5
• An orally-disintegrating tablet (ODT) formulation of metoclopramide has been developed to improve patient adherence to therapy, especially for those with difficulty swallowing tablets or nausea/vomiting 6
• The ODT formulation has been shown to be bioequivalent to conventional metoclopramide tablets 6

Side Effects

• Common side effects of metoclopramide include drowsiness, restlessness, hyperprolactinemia, and tardive dyskinesia (TD), a movement disorder that may be irreversible 4
• The risk of side effects can be minimized by using the lowest effective dose and monitoring patients closely for signs of adverse reactions 7