Recommended Dosage of Metoclopramide
The standard dose of metoclopramide is 5-20 mg orally or intravenously, with specific dosing dependent on the indication and patient factors. 1
Dosing by Route of Administration
Oral Administration
- Standard adult dose: 5-20 mg per dose 1
- Typical regimen: 10 mg three to four times daily 1
- Maximum daily dose: 0.5 mg/kg/day (typically not exceeding 40 mg daily)
Intravenous Administration
- Standard adult dose: 5-20 mg per dose 1
- For chemotherapy-induced nausea/vomiting: 1-2 mg/kg IV 2, 3
- Maximum single IV dose: 20 mg
Dosing by Indication
Antiemetic Use
- Radiation therapy-induced nausea: 5-20 mg as breakthrough therapy 1
- Chemotherapy-induced nausea: 1-2 mg/kg IV every 2 hours for up to 5 doses 2, 3
- Pregnancy-related nausea: 10 mg three times daily 1
- Migraine-associated nausea: 10 mg orally or IV as adjunctive therapy 1
Gastrointestinal Motility
- GERD/reflux: 10 mg three to four times daily 1
- Gastroparesis: 10 mg four times daily before meals and at bedtime 4
- Lower GI bleeding preparation: 10 mg IV approximately 30 minutes before bowel purge 1
Special Considerations
Duration of Therapy
- Short-term use recommended (typically 4-12 weeks for oral therapy) 4
- Parenteral use should be limited to 1-2 days when possible 4
Adverse Effects to Monitor
- Extrapyramidal symptoms: More common at doses ≥2 mg/kg or with prolonged use 2, 5
- Akathisia: Reported in 33% of pediatric patients at doses ≥2 mg/kg 2
- Sedation/drowsiness: Common side effect at standard doses 4
- Tardive dyskinesia: Risk increases with prolonged use and higher cumulative doses
Precautions
- Renal impairment: Dose adjustment recommended as renal clearance accounts for 20% of total clearance 6
- Age considerations: Younger patients have increased risk of extrapyramidal reactions 2
- Concomitant medications: Consider adding diphenhydramine to reduce extrapyramidal reactions when using higher doses 2
Practical Dosing Algorithm
Start with lowest effective dose:
- For most indications: 10 mg three times daily
- For mild symptoms: 5 mg three times daily
Titrate based on response:
- If inadequate response after 48 hours, increase to 10 mg four times daily
- Maximum oral daily dose: 40 mg
Duration:
- Limit use to shortest duration needed (ideally <12 weeks)
- For acute symptoms: 1-3 days
- For chronic conditions: Reassess necessity after 4 weeks
Discontinuation:
- Taper gradually if used for >3 weeks to avoid withdrawal symptoms
Remember that metoclopramide is generally not intended for long-term use due to the risk of tardive dyskinesia and other neurological adverse effects 4.