From the Guidelines
For ICU ileus, Metoclopramide (Reglan) is recommended as a prokinetic agent to lower the risk of feeding intolerance, with a weak recommendation based on moderate-quality evidence 1. The use of Metoclopramide in ICU patients with ileus is supported by a systematic review and meta-analysis that showed a lower risk of feeding intolerance (RR, 0.73; 95% CI, 0.55–0.97) with prokinetic agent use, including Metoclopramide or erythromycin 1. Key considerations for Metoclopramide administration in ICU ileus include:
- Dosage: typically 10 mg intravenously every 6 hours for 3-5 days or until bowel function returns
- Administration timing: 30 minutes before meals and at bedtime when transitioning to oral administration
- Dosage adjustments: necessary for patients with renal impairment, with a 50% reduction recommended for creatinine clearance below 40 mL/min
- Treatment duration: limited to short-term use (less than 12 weeks) due to the risk of tardive dyskinesia with prolonged use
- Monitoring: for extrapyramidal symptoms, particularly in younger patients, and avoidance of use in patients with seizure disorders, pheochromocytoma, or GI obstruction
- Concurrent administration: may reduce effectiveness with anticholinergics The comprehensive management of ICU ileus should include early mobilization, minimizing opioid use, and maintaining electrolyte balance, in addition to Metoclopramide therapy 1.
From the FDA Drug Label
For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated. However, if severe symptoms are present, therapy should begin with Metoclopramide Injection (intramuscular or intravenous) Doses of 10 mg may be administered slowly by the intravenous route over a 1 to 2 minute period.
The recommended treatment for ICU ileus using Reglan (Metoclopramide) is not explicitly stated in the provided drug label. However, based on the information provided for diabetic gastroparesis, 10 mg of Metoclopramide may be administered slowly by the intravenous route over a 1 to 2 minute period for severe symptoms.
- The treatment should be initiated with caution and under close monitoring, especially in critically ill patients.
- It is essential to assess the risks and benefits prior to prescribing Metoclopramide treatment 2.
From the Research
Treatment of ICU Ileus using Reglan (Metoclopramide)
- The use of Reglan (Metoclopramide) for treating ICU ileus is not widely supported by the provided evidence 3, 4, 5.
- According to a study published in 2019, neither metoclopramide nor erythromycin appear to have a role in the treatment of ileus 3.
- A practice management guideline from the Eastern Association for the Surgery of Trauma also found that metoclopramide was not effective in expediting the resolution of ileus in adult surgical patients 4.
- However, metoclopramide may be used to improve gastric feeding tolerance in trauma patients, although its efficacy may be lower in patients with traumatic brain injury 5.
- In some cases, metoclopramide has been used in combination with erythromycin to treat ileus, such as in a case report of methamphetamine-induced ileus 6.
Alternative Treatments for ICU Ileus
- Neostigmine has been shown to be effective in promoting defecation in ICU patients with colonic ileus 7.
- Early enteral nutrition (EEN) has also been recommended to expedite the resolution of ileus in adult surgical patients 4.
- Other treatments, such as ghrelin agonists, highly selective 5-hydroxytryptamine receptor agonists, and opiate antagonists, are being studied in clinical trials 3.