Metoclopramide Dosing for a 13-Year-Old Female Weighing 60kg
For a 13-year-old female weighing 60kg, the recommended dose of metoclopramide is 10mg per dose, given up to three times daily, with a maximum daily dose of 30mg. 1
Dosing Considerations
The appropriate dosing for metoclopramide in pediatric patients is based on both age and weight:
- For children weighing >40kg (like this 13-year-old patient at 60kg): 10mg per dose is appropriate
- Frequency: Typically administered three times daily before meals
- Maximum daily dose: Should not exceed 30mg per day
- Route of administration: Oral administration is preferred for routine use
Safety Concerns and Monitoring
Metoclopramide carries significant risks in pediatric patients that require careful consideration:
- Extrapyramidal symptoms (EPS): The most concerning adverse effect, particularly in adolescents
- Risk of neuroleptic malignant syndrome: A rare but serious complication reported even in pediatric patients 2
- Long-lasting adverse effects: Cases of persistent neurological symptoms have been reported even after short-term use 3
Monitoring Requirements
- Monitor for signs of EPS: muscle rigidity, involuntary movements, tremors
- Assess for symptoms of akathisia: restlessness, inability to sit still
- Watch for changes in mental status or hyperthermia
Duration of Treatment
- Limit treatment to the shortest duration possible (ideally ≤5 days)
- Avoid continuous use beyond 12 weeks due to risk of tardive dyskinesia
- Consider discontinuation if adverse effects occur
Important Precautions
Avoid high doses: Studies show that doses ≥2 mg/kg significantly increase risk of EPS in children, with 15% experiencing EPS at this threshold 4
Consider diphenhydramine: May be co-administered to reduce risk of extrapyramidal symptoms
Contraindications:
- History of seizure disorders
- Pheochromocytoma
- GI obstruction or bleeding
Alternative Options
If metoclopramide is not tolerated or contraindicated, consider:
- Ondansetron (age-appropriate dosing)
- Prochlorperazine (for patients >12 years)
- Non-pharmacological approaches when appropriate
Remember that metoclopramide should be used cautiously in pediatric patients due to the higher risk of adverse effects in this population compared to adults, particularly neurological side effects that may persist even after discontinuation of the medication.