From the Guidelines
No, Reglan (Metoclopramide) is not safe to use in intestinal obstruction or paralytic ileus, especially in patients with complete obstruction, as it can increase gastrointestinal mobility and worsen the condition 1.
Key Considerations
- In patients with partial obstruction, metoclopramide may be beneficial, but its use should be approached with caution and careful consideration of the individual patient's condition.
- The primary goal of treatment in malignant bowel obstruction is to relieve distressing symptoms, and pharmacologic management should be tailored to the individual patient's needs and goals of care.
- Alternative pharmacologic options, such as somatostatin analogs (e.g., octreotide) and/or anticholinergics, may be more suitable for patients with complete obstruction or those for whom gut function is no longer possible 1.
- A thorough evaluation of the patient's condition, including the extent of obstruction and overall clinical status, is essential to determine the most appropriate treatment approach.
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.
Reglan (Metoclopramide) is not safe to use in intestinal obstruction or paralytic ileus, as it may stimulate gastrointestinal motility, which could be dangerous in these conditions 2.
- Contraindications include mechanical obstruction, which encompasses intestinal obstruction.
- The use of Metoclopramide in such cases is explicitly contraindicated.
From the Research
Safety of Reglan (Metoclopramide) in Intestinal Obstruction or Paralytic Ileus
- The use of metoclopramide in intestinal obstruction or paralytic ileus has been investigated in several studies 3, 4, 5, 6, 7.
- A study published in 1993 found that metoclopramide is currently used exclusively for proximal motility dysfunction, but its effectiveness in colonic motility disorders is limited 3.
- However, a 2024 study found that the combination of dexamethasone, octreotide, and metoclopramide may lead to relief of obstruction and improvement in symptoms associated with malignant bowel obstruction 4.
- Another study published in 1989 found that metoclopramide reversed the inhibition of gastrointestinal myoelectric and contractile activity in a model of canine postoperative ileus 5.
- A 2019 guideline from the Eastern Association for the Surgery of Trauma found that neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus in adult surgical patients, but early enteral nutrition was recommended to expedite resolution of ileus 6.
- A case report published in 1981 found that metoclopramide was effective in resolving prolonged ileus in a patient with acute spinal cord injury 7.
Key Findings
- Metoclopramide may be effective in relieving symptoms associated with malignant bowel obstruction 4.
- Metoclopramide can reverse the inhibition of gastrointestinal myoelectric and contractile activity in postoperative ileus 5.
- Metoclopramide may not be effective in expediting the resolution of ileus in adult surgical patients 6.
- Metoclopramide can be used to resolve prolonged ileus in patients with acute spinal cord injury 7.