From the Guidelines
For treating ileus, metoclopramide is typically administered at a dose of 5-20 mg tid-qid, with a recommended dose of 10 mg tid-qid, as this regimen has been shown to be effective in accelerating gastric emptying and improving symptoms. This recommendation is based on the most recent and highest quality study available, which suggests that metoclopramide is effective in treating gastroparesis and ileus 1. The dose and frequency of metoclopramide may vary depending on the individual patient's response and medical history. It's essential to note that metoclopramide has limited efficacy in postoperative ileus and is contraindicated in complete bowel obstruction, pheochromocytoma, and in patients taking medications that can cause extrapyramidal reactions.
Some key points to consider when using metoclopramide for ileus include:
- The medication should be used for short-term treatment, ideally not exceeding 5 days, due to the risk of neurological side effects with prolonged use.
- In patients with renal impairment, the dose should be reduced by 50%.
- Metoclopramide works by increasing gastrointestinal motility through its action as a dopamine antagonist and by stimulating the release of acetylcholine in the gut.
- Common side effects include drowsiness, restlessness, and extrapyramidal symptoms.
- Before initiating treatment, ensure the patient doesn't have conditions where increased gastrointestinal motility might be harmful, such as gastrointestinal hemorrhage or perforation.
It's also important to consider alternative treatment options, such as erythromycin, which has been shown to be effective in accelerating gastric emptying and improving symptoms in patients with gastroparesis and ileus 1. However, the use of erythromycin should be limited to 24-48 hours due to the risk of QT prolongation and cardiac arrhythmias.
In summary, metoclopramide is a effective treatment option for ileus, but its use should be carefully considered and monitored due to the potential risks and side effects. The recommended dose and frequency of metoclopramide for treating ileus is 10 mg tid-qid, with a maximum duration of treatment of 5 days 1.
From the Research
Dose and Frequency of Metoclopramide for Ileus
- The recommended dose and frequency of metoclopramide for treating ileus is not consistently established across studies 2, 3, 4, 5, 6.
- One study used intravenous metoclopramide, but the dose and frequency are not specified 2.
- Another study used metoclopramide at a dose of 0.4 mg/kg four times daily (QID) intravenously (IV) in a canine model of postoperative ileus 5.
- However, the effectiveness of metoclopramide in expediting the resolution of ileus is uncertain, and some studies found it to be ineffective 3, 4.
Efficacy of Metoclopramide in Treating Ileus
- The evidence suggests that metoclopramide may not be effective in reducing the duration of postoperative ileus 3, 4.
- One study found that metoclopramide reversed the inhibition of the migrating myoelectric complex (MMC) phase III at the antrum and pylorus, and partially reversed the inhibition at the duodenum and jejunum in a canine model of postoperative ileus 5.
- However, the clinical significance of this finding is unclear, and more research is needed to determine the efficacy of metoclopramide in treating ileus.
Comparison with Other Treatments
- Early enteral nutrition (EEN) has been shown to be effective in expediting the resolution of ileus in adult surgical patients 3.
- Other prokinetic agents, such as erythromycin and cisapride, have also been studied, but their effectiveness is uncertain 3, 4.
- Methylnaltrexone, a peripherally acting μ-opioid receptor antagonist, has been evaluated for its safety and efficacy in shortening the duration of postoperative ileus, but its utility remains unproven 6.