Recommended Dose of Metoclopramide for Adults
The recommended dose of metoclopramide for adults is 5-20 mg orally or intravenously. 1
Dosing Guidelines by Route of Administration
Oral Administration
- Standard adult dose: 5-20 mg orally 1
- For nausea and vomiting: 10 mg orally every 6 hours as needed 1
- For breakthrough antiemetic therapy: 5-20 mg orally 1
Intravenous Administration
- Standard adult dose: 5-20 mg IV 1
- For prevention of chemotherapy-induced nausea: 10 mg IV administered slowly over 1-2 minutes 2
- For highly emetogenic chemotherapy: 2 mg/kg IV 30 minutes before chemotherapy, repeated every 2 hours for two doses, then every 3 hours for three doses 2
- For less emetogenic regimens: 1 mg/kg IV per dose 2
Dosing Considerations for Specific Conditions
Antiemetic Use
- For breakthrough nausea/vomiting during radiation therapy: 5-20 mg orally or IV 1
- For opioid-induced nausea: 10 mg orally or IV 1
- For prevention of postoperative nausea and vomiting: 10 mg IV (doses of 20 mg may be used) 2
Gastrointestinal Motility
- For diabetic gastroparesis: 10 mg orally or IV (administered slowly over 1-2 minutes) 2
- To facilitate small bowel intubation: 10 mg IV administered slowly over 1-2 minutes 2
- For radiological examinations: 10 mg IV administered slowly over 1-2 minutes 2
Important Dosing Considerations
Renal Impairment
- For patients with creatinine clearance below 40 mL/min: Start with approximately half the recommended dose 2
- Adjust dose based on clinical efficacy and safety considerations 2
Timing of Administration
- For chemotherapy-induced nausea: Administer 30 minutes before beginning chemotherapy 2
- For opioid-induced nausea: Can be administered 30 minutes before or with analgesics 1
Adverse Effects to Monitor
Common Adverse Effects
Serious but Rare Adverse Effects
- Dysrhythmia
- Respiratory distress/arrest
- Neuroleptic malignant syndrome
- Tardive dyskinesia 3
Precautions and Contraindications
- Use with caution in elderly patients due to increased risk of extrapyramidal symptoms
- Consider diphenhydramine co-administration to reduce risk of extrapyramidal reactions, particularly when using higher doses 4
- Avoid prolonged use (>5 days) when possible due to risk of tardive dyskinesia
Metoclopramide is a versatile antiemetic medication with established efficacy across multiple indications. The standard adult dose range of 5-20 mg provides flexibility for clinicians to adjust based on the specific clinical scenario, severity of symptoms, and patient characteristics.