What are the contraindications for Reglan (metoclopramide)?

From the Guidelines

Reglan (metoclopramide) is contraindicated in patients with pheochromocytoma, seizure disorders, gastrointestinal obstruction, perforation, or hemorrhage, and those with a history of sensitivity or allergy to the medication. The use of metoclopramide is also cautioned against in patients taking medications that can cause extrapyramidal reactions, such as antipsychotics, due to the additive risk of movement disorders 1. Additionally, Reglan should not be used in patients with Parkinson's disease as it blocks dopamine receptors and can worsen symptoms. It is also contraindicated with MAO inhibitors due to potential serious interactions.

Some of the key contraindications and precautions for metoclopramide include:

• Pheochromocytoma, as it can trigger a dangerous hypertensive crisis
• Seizure disorders, as it may increase seizure risk
• Gastrointestinal obstruction, perforation, or hemorrhage, where stimulating GI motility could be harmful
• Known sensitivity or allergy to the medication
• Patients taking medications that can cause extrapyramidal reactions
• Parkinson's disease, as it blocks dopamine receptors and can worsen symptoms
• MAO inhibitors, due to potential serious interactions

According to the most recent evidence, metoclopramide's use is recommended with caution in elderly patients, those with kidney or liver impairment, and during pregnancy, as the benefits and risks need to be carefully weighed 1. The European Medicines Agency’s Committee has also recommended that metoclopramide is not used in the long term due to the risk of extrapyramidal side effects and potentially irreversible tardive dyskinesia in elderly subjects.

From the FDA Drug Label

Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction or perforation. Metoclopramide is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phentolamine. Metoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug. Metoclopramide should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

The contraindications for Reglan (metoclopramide) are:

• Gastrointestinal hemorrhage
• Mechanical obstruction
• Perforation
• Pheochromocytoma
• Known sensitivity or intolerance to the drug
• Epileptics
• Patients receiving other drugs that may cause extrapyramidal reactions 2 Additionally, according to another source, metoclopramide is also contraindicated in patients with:
• Stomach or intestine problems that could get worse with metoclopramide, such as bleeding, blockage or a tear in the stomach or bowel wall
• Adrenal gland tumor called pheochromocytoma
• Allergic to metoclopramide or anything in it
• Take medicines that can cause uncontrolled movements, such as medicines for mental illness
• Have seizures 2

From the Research

Reglan Contraindications

The contraindications for Reglan (metoclopramide) include:

• Tardive dyskinesia, a condition characterized by involuntary, repetitive body movements, which can be caused by long-term use of metoclopramide 3, 4, 5
• Extrapyramidal movement disorders, such as parkinsonism, akathisia, and dystonia, which can be induced by metoclopramide 4, 5, 6
• Patients with a history of seizure disorders, as metoclopramide may lower the seizure threshold 3
• Patients with pheochromocytoma, a rare tumor of the adrenal gland, as metoclopramide may cause a hypertensive crisis 3
• Patients with epilepsy, as metoclopramide may increase the risk of seizures 3

High-Risk Groups

Certain groups of people are at a higher risk of developing contraindications when taking Reglan, including:

• Elderly females, who are more likely to develop tardive dyskinesia and other extrapyramidal movement disorders 3, 7
• Diabetics, who may be more susceptible to the development of tardive dyskinesia and other movement disorders 4
• Patients with liver or kidney failure, who may be more likely to experience adverse reactions to metoclopramide due to impaired drug clearance 3, 6
• Patients taking antipsychotic medications, which may increase the risk of developing extrapyramidal movement disorders when combined with metoclopramide 3