What is the recommended round-the-clock dose for Reglan (metoclopramide)?

Round-the-Clock Dosing for Metoclopramide (Reglan)

The standard round-the-clock dosing for metoclopramide (Reglan) is 10 mg orally every 6 hours. This dosing regimen is appropriate for most indications requiring continuous administration.

Dosing Guidelines

Metoclopramide is typically administered according to the following schedule:

• Standard adult dose: 10 mg orally every 6 hours (40 mg total daily dose) 1
• Maximum daily dose: Should not exceed 40 mg per day in most cases
• Duration: Generally not intended for long-term use; oral preparations are recommended for 4-12 weeks of therapy 2

Indications for Round-the-Clock Dosing

Metoclopramide may be prescribed as a round-the-clock medication for:

1. Gastroparesis: Particularly in diabetic patients
2. Severe gastroesophageal reflux disease
3. Persistent nausea and vomiting: When other antiemetics have failed
4. Adjunctive therapy for cancer-related nausea: Often used in combination with other antiemetics 1

Administration Routes

Depending on the clinical situation, metoclopramide can be administered via multiple routes:

• Oral: 10 mg every 6 hours
• Intravenous: 10-20 mg every 6 hours (for short-term use only) 1
• Intramuscular: 10 mg every 6 hours (for short-term use only)

Important Considerations and Precautions

Duration Limitations

• Parenteral metoclopramide should be limited to 1-2 days 2
• Oral therapy should generally not exceed 12 weeks due to risk of tardive dyskinesia

Adverse Effects

• Common: Restlessness, drowsiness, fatigue, lassitude 2
• Serious: Extrapyramidal symptoms (more common with high doses or prolonged use)
• Rare but severe: Long-lasting movement disorders even after short-term use 3

Special Populations

• Pediatric patients: Increased risk of extrapyramidal reactions; dosing should be carefully calculated by weight 4
• Elderly: Consider lower doses due to increased sensitivity to side effects

Monitoring During Therapy

When administering metoclopramide around the clock:

1. Monitor for extrapyramidal symptoms (tremors, muscle rigidity, akathisia)
2. Assess for sedation and mental status changes
3. Evaluate effectiveness in controlling target symptoms
4. Consider discontinuation if adverse effects occur or after 12 weeks of therapy

Alternative Approaches

If metoclopramide is ineffective or contraindicated, consider:

• Dopamine receptor antagonists (e.g., haloperidol, prochlorperazine) 1
• Serotonin antagonists for chemotherapy-induced nausea 1
• Prokinetic alternatives with different mechanisms of action

Remember that metoclopramide should be used judiciously, with the shortest duration and lowest effective dose to minimize the risk of adverse effects while achieving symptom control.