What is the dose and frequency of Reglan (metoclopramide) when used as needed (prn)?

From the Guidelines

The recommended dose of Reglan (metoclopramide) for PRN use is 10 mg taken up to four times daily, with a maximum daily dose of 40 mg. This dosage is based on the most recent and highest quality study available, which suggests that metoclopramide can be effective in managing symptoms of gastroparesis when used at a dose of 5-20 mg tid-qid 1. For PRN use, it is essential to balance the need for symptom relief with the risk of adverse effects, such as tardive dyskinesia, which is associated with long-term use of metoclopramide.

Some key points to consider when using Reglan PRN include:

• Taking the medication at least 30 minutes before meals and at bedtime to maximize its effectiveness in accelerating gastric emptying
• Waiting at least 2 hours between doses to minimize the risk of adverse effects
• Not exceeding the maximum daily dose of 40 mg to reduce the risk of tardive dyskinesia and other adverse effects
• Considering lower doses of 5 mg for elderly patients or those with renal impairment, as they may be more susceptible to the adverse effects of metoclopramide 1

It is also important to note that metoclopramide is the only FDA-approved medication for gastroparesis, and its use should be limited to short durations when possible due to the risk of tardive dyskinesia 1. Common side effects of metoclopramide include drowsiness, restlessness, and fatigue, so patients should use caution when driving or operating machinery after taking this medication.

From the Research

Dose and Frequency of Reglan (Metoclopramide) for prn Use

• The dose of Reglan (metoclopramide) when used as needed (prn) is not explicitly stated in the provided studies, but the studies mention various doses used in different contexts:
  • 10 mg intramuscularly or intravenously for prevention and treatment of nausea and vomiting 2, 3
  • 5-10 mg orally per day for treatment of vomiting 2
  • 10 mg intravenously for prevention of postoperative nausea and vomiting 3
• The frequency of use is also not explicitly stated, but the studies suggest that metoclopramide can be used as needed, with some studies administering the medication every 6-8 hours as needed 3
• It is essential to note that metoclopramide should be used with caution, especially in high-risk groups, due to the potential risk of tardive dyskinesia and other adverse effects 4

Adverse Effects and Contraindications

• Metoclopramide can cause adverse effects such as dizziness, anxiety, fatigue, depression, and involuntary movements 2
• The risk of tardive dyskinesia is low, but it is essential to consider this risk when starting a course of metoclopramide, especially in high-risk groups such as elderly females, diabetics, and patients with liver or kidney failure 4
• Metoclopramide should be reserved for debilitating cases and only given after other remedies have been tried and found ineffective 2

Administration and Dosage

• Metoclopramide can be administered intramuscularly, intravenously, or orally 2, 3
• The dosage and administration route may vary depending on the specific context and patient population 3
• Co-administration of diphenhydramine may help reduce the risk of akathisia, but routine prophylaxis is not recommended 5