Round-the-Clock Dosing for Metoclopramide (Reglan)
The standard round-the-clock dosing for metoclopramide (Reglan) is 10 mg orally three to four times daily, with a maximum daily dose of 40 mg. 1
Dosing Guidelines
Metoclopramide is typically administered according to the following schedule:
- Standard adult dose: 10 mg three to four times daily 1
- Maximum daily dose: 0.5 mg/kg/day, typically not exceeding 40 mg daily 1
- Timing: Usually administered 30 minutes before meals and at bedtime
Administration Considerations
When administering metoclopramide on a round-the-clock basis:
- Duration: Short-term use is recommended, typically 4-12 weeks for oral therapy 2
- Route:
- Oral administration is preferred for ongoing therapy
- Parenteral use (IV/IM) should be limited to 1-2 days when possible 2
Special Patient Populations
Dose adjustments may be necessary in certain populations:
- Renal impairment: For patients with creatinine clearance below 40 mL/min, therapy should be initiated at approximately half the recommended dosage 3
- Elderly patients: May be more susceptible to side effects, particularly extrapyramidal symptoms
- Pediatric patients: Dosing is weight-based and not typically used for round-the-clock administration
Monitoring and Safety Considerations
When using metoclopramide on a round-the-clock basis, be aware of:
- Extrapyramidal symptoms: Can occur with higher doses or prolonged use 2
- Tardive dyskinesia risk: Although the risk is lower than previously thought (approximately 0.1% per 1000 patient years), it increases with longer duration of treatment 4
- High-risk groups: Elderly females, diabetics, patients with liver or kidney failure, and those on concomitant antipsychotic therapy have increased risk of neurological complications 4
Alternative Administration for Breakthrough Symptoms
For breakthrough symptoms when oral administration is not feasible:
- Rectal or IV therapy may be required 5
- Around-the-clock administration is preferred over PRN dosing for persistent symptoms 5
Important Cautions
- Metoclopramide is generally not intended for long-term use 2
- Even short-term, low-dose treatment can occasionally lead to adverse effects that may persist for months after discontinuation 6
- Always start with the lowest effective dose and titrate based on response 1
Remember that metoclopramide's onset of action is 30-60 minutes following oral administration, with pharmacological effects persisting for 1-2 hours 3, which supports the need for multiple daily doses when used on a round-the-clock basis.