From the Research
Metoclopramide can be used to address vomiting caused by Nubain (nalbuphine), but due to its side effect profile, it is recommended to use it with caution and consider alternative antiemetics like ondansetron, which has shown superior efficacy and safety in recent studies 1. The recommended dosage for adults is typically 10 mg administered intravenously or intramuscularly every 6 hours as needed for nausea and vomiting. For oral administration, 10-15 mg up to four times daily can be used. Treatment duration should be limited to the shortest time necessary, generally not exceeding 5 days, to minimize the risk of side effects, as seen in a case report where a patient experienced long-lasting adverse effects after short-term, low-dose use of metoclopramide 2. Metoclopramide works by blocking dopamine receptors in the chemoreceptor trigger zone and accelerating gastric emptying, which helps counteract the nausea and vomiting that can occur as side effects of opioid medications like nalbuphine. Patients should be monitored for potential side effects of metoclopramide, including drowsiness, restlessness, and extrapyramidal symptoms (particularly with prolonged use), as noted in a study comparing the effectiveness of antiemetic drugs 3. Lower doses may be appropriate for elderly patients or those with renal impairment. If metoclopramide is ineffective, alternative antiemetics such as ondansetron or promethazine might be considered, as they have shown comparable or superior efficacy in reducing nausea and vomiting in various clinical settings 4, 5. It's essential to weigh the benefits and risks of metoclopramide and consider the most recent and highest-quality evidence when making treatment decisions, prioritizing the patient's morbidity, mortality, and quality of life as the primary outcome.