Metoclopramide (Reglan) Dosing for Nausea Management
The standard dosing frequency for metoclopramide (Reglan) in managing nausea is 10 mg three to four times daily. 1
Standard Dosing Guidelines
- Oral administration: 10 mg three to four times daily 1
- Intravenous/intramuscular administration: 10 mg every 4-6 hours as needed 2
- Maximum daily dose: 0.5 mg/kg/day, typically not exceeding 40 mg daily 1
Route-Specific Considerations
Oral Route
- Start with 10 mg three times daily before meals and at bedtime if needed
- For ongoing therapy, oral administration is preferred over parenteral routes 1
Parenteral Route (IV/IM)
- Should be limited to 1-2 days when possible 1, 3
- IV administration should be done slowly over 1-2 minutes 4
- For breakthrough nausea: 10-40 mg IV either every 4 or 6 hours 2
Special Populations and Considerations
Renal Impairment
- For patients with creatinine clearance below 40 mL/min, start at approximately half the recommended dose 4
- Titrate based on efficacy and safety considerations
High-Risk Groups
- Elderly females, diabetics, and patients with liver or kidney failure have increased risk of neurological complications 1
- Younger patients have increased risk of extrapyramidal reactions 1
Duration of Treatment
- Metoclopramide is generally not intended for long-term use 3
- Oral preparations are recommended for 4-12 weeks maximum 3
- Parenteral use should be limited to 1-2 days 3
Potential Adverse Effects to Monitor
- Extrapyramidal symptoms (risk increases with higher doses and prolonged use) 3
- Risk of tardive dyskinesia increases with longer duration of treatment (approximately 0.1% per 1000 patient years) 1
- Common side effects: restlessness, drowsiness, fatigue 3
Important Cautions
- For persistent nausea despite metoclopramide treatment, consider adding a second agent such as ondansetron 2
- Consider diphenhydramine (25-50 mg) to manage extrapyramidal reactions if they occur 2
- Monitor closely for dystonic reactions, especially with higher doses 2
- Avoid long-term use due to risk of tardive dyskinesia 3, 5
Always start with the lowest effective dose and titrate based on response while monitoring for adverse effects. The goal is to achieve symptom control while minimizing the risk of neurological complications.