Metoclopramide Dosing for Nausea and Vomiting
The standard dosing of metoclopramide for treating nausea and vomiting is 10 mg orally every 6 hours, with a maximum daily dose of 40 mg. 1, 2
Route-Specific Dosing
Oral Administration
- Standard dose: 10 mg every 6 hours
- Maximum daily dose: 40 mg
Parenteral Administration
- Intramuscular: 10 mg every 6 hours
- Intravenous: 10 mg administered slowly over 1-2 minutes
- For severe nausea/vomiting: Can be given every 6 hours
- IV administration should be done slowly to minimize side effects
Indication-Specific Dosing
Diabetic Gastroparesis
- Initial dose: 10 mg orally 30 minutes before meals and at bedtime
- Duration: Treatment may be required for up to 10 days before symptoms subside 2
Chemotherapy-Induced Nausea and Vomiting
- Dosing: 1-2 mg/kg IV
- Administration: Given 30 minutes before chemotherapy, then every 2 hours for two doses, followed by every 3 hours for three doses 2
Postoperative Nausea and Vomiting
- Standard dose: 10 mg IM near the end of surgery
- Alternative dose: 20 mg may be used in some cases 2
Special Populations
Renal Impairment
- For patients with creatinine clearance below 40 mL/min: Start with approximately half the recommended dose
- Adjust based on efficacy and safety 2
Elderly Patients
- Consider lower doses due to increased sensitivity to side effects
- Monitor closely for extrapyramidal symptoms
Safety Considerations
Black Box Warning
- Risk of tardive dyskinesia with long-term use or high doses
- Limit treatment duration when possible
Common Adverse Effects
- Sedation, dizziness, drowsiness
- Extrapyramidal symptoms (particularly in young patients)
Monitoring
- Watch for involuntary movements (twitches, jerks, tics, tremors)
- Serious adverse effects can occur even with short-term, low-dose use 3
Alternative Antiemetics
If metoclopramide is ineffective or contraindicated, consider:
- Dopamine receptor antagonists (haloperidol, prochlorperazine) 4
- Serotonin antagonists (ondansetron) for chemotherapy-induced nausea 4
Research indicates that higher doses of metoclopramide (0.4 mg/kg) do not provide additional benefit over the standard 10 mg dose for emergency department patients with nausea and vomiting 5.