Metoclopramide Dosing for Nausea Treatment
The recommended dosage of metoclopramide (Reglan) for treating nausea is 10 mg orally or intravenously three to four times daily, with a maximum daily dose of 40 mg. 1
Standard Dosing Regimens
Oral Administration
- Standard dose: 10 mg three to four times daily 1
- Starting dose should be the lowest effective dose (typically 10 mg) 1
- Maximum daily dose: 0.5 mg/kg/day, not exceeding 40 mg daily 1
Parenteral Administration (IV/IM)
- Standard dose: 10 mg administered slowly over 1-2 minutes 2
- Parenteral use should be limited to 1-2 days when possible 1
- For severe symptoms, IV administration may be preferred initially 2
Indication-Specific Dosing
Chemotherapy-Induced Nausea and Vomiting
- For highly emetogenic chemotherapy: 2 mg/kg IV 30 minutes before chemotherapy, repeated every 2 hours for two doses, then every 3 hours for three doses 2
- For less emetogenic regimens: 1 mg/kg per dose 2
- IV infusions should be administered slowly over at least 15 minutes 2
Diabetic Gastroparesis
- 10 mg IV administered slowly over 1-2 minutes 2
- Treatment for up to 10 days may be required before transitioning to oral therapy 2
Postoperative Nausea and Vomiting
- 10 mg IM near the end of surgery (20 mg may be used in some cases) 2
- Number needed to treat to prevent early vomiting: 9.1 3
Migraine-Associated Nausea
Special Populations
Renal Impairment
- For patients with creatinine clearance below 40 mL/min, start with approximately half the recommended dose 2
- Dose can be adjusted based on clinical efficacy and safety 2
Pediatric Patients
- For children 6-14 years: 2.5-5 mg 2
- For children under 6 years: 0.1 mg/kg 2
- Higher risk of extrapyramidal reactions in younger patients 1, 5
Adverse Effects and Precautions
Extrapyramidal Symptoms
- Risk increases with higher doses and longer duration of treatment 1
- Consider adding diphenhydramine to reduce extrapyramidal reactions when using higher doses 1, 5
- Acute dystonic reactions can be treated with 50 mg diphenhydramine IM 2
High-Risk Groups
- Elderly females, diabetics, patients with liver or kidney failure, and those on concomitant antipsychotic therapy have increased risk of neurological complications 1
- Risk of tardive dyskinesia increases with longer treatment duration (approximately 0.1% per 1000 patient years) 1
Administration Tips
- For oral therapy, around-the-clock administration is preferred over PRN dosing for persistent symptoms 1
- For IV administration, inspect solution for particulate matter and discoloration prior to administration 2
- When diluted in appropriate solutions, metoclopramide can be stored up to 48 hours if protected from light 2
Metoclopramide should be used at the lowest effective dose for the shortest duration possible to minimize the risk of adverse effects, particularly extrapyramidal symptoms and tardive dyskinesia, which can occasionally be severe and long-lasting even after short-term use 6.