What is the recommended dosing for metoclopramide (antiemetic medication)?

Metoclopramide Dosing Recommendations

The standard dose of metoclopramide is 10 mg orally or intravenously three to four times daily, with a maximum daily dose of 40 mg. 1

Standard Dosing by Route and Indication

Oral Administration

• Standard oral dose: 10 mg 3-4 times daily 1
• Maximum daily dose: 0.5 mg/kg/day, not exceeding 40 mg daily 1
• Diabetic gastroparesis: 10 mg orally, 30 minutes before meals and at bedtime 2

Intravenous Administration

• Standard IV dose: 10 mg administered slowly over 1-2 minutes 3
• Chemotherapy-induced nausea/vomiting:
  • For highly emetogenic regimens: 2 mg/kg IV over ≥15 minutes, 30 minutes before chemotherapy, repeated every 2 hours for 2 doses, then every 3 hours for 3 doses 3
  • For less emetogenic regimens: 1 mg/kg per dose 3
• Postoperative nausea/vomiting: 10 mg IM near end of surgery (20 mg may be used) 3

Special Population Considerations

Renal Impairment

• For creatinine clearance <40 mL/min: Start at approximately half the recommended dose 2, 3
• Titrate based on efficacy and safety 2, 3

Pediatric Dosing

• Children >14 years: Same as adult dosing (10 mg) 3
• Children 6-14 years: 2.5-5 mg 3
• Children <6 years: 0.1 mg/kg 3
• Higher risk of extrapyramidal reactions in younger patients 1, 4

Administration Considerations

• For IV doses >10 mg, dilute in 50 mL of parenteral solution (preferably normal saline) 3
• IV administration should be done slowly over 1-2 minutes for standard doses 3
• For chemotherapy-induced nausea, infuse slowly over at least 15 minutes 3

Side Effect Management

• For acute dystonic reactions: 50 mg diphenhydramine IM 3
• Consider prophylactic diphenhydramine to reduce extrapyramidal reactions when using higher doses, especially in younger patients 1, 4
• Metoclopramide should be used at the lowest effective dose to minimize risk of tardive dyskinesia 1

Important Cautions

• High-risk groups for neurological complications include elderly females, diabetics, patients with liver or kidney failure, and those on concomitant antipsychotic therapy 1
• Risk of tardive dyskinesia increases with longer duration of treatment (approximately 0.1% per 1000 patient years) 1
• Parenteral use should be limited to 1-2 days when possible 1

This dosing guidance is based on FDA labeling and clinical guidelines, with adjustments needed for specific patient factors such as age, renal function, and concomitant medications to minimize adverse effects while maximizing therapeutic benefit.