Recommended Dosage of Metoclopramide (Reglan) for Nausea
The standard dose of metoclopramide for nausea is 10 mg orally or intravenously 3-4 times daily, with a maximum daily dose of 40 mg. 1
Dosage Guidelines by Route of Administration
Oral Administration
- Standard dose: 10 mg three to four times daily 1
- Starting dose: Consider 5 mg for elderly patients or those with renal impairment 2
- Maximum daily dose: 0.5 mg/kg/day, not exceeding 40 mg daily 1
Parenteral Administration (IV/IM)
- Standard dose: 10 mg IV/IM every 4-6 hours as needed 1
- Administration rate: Administer IV doses slowly over 1-2 minutes to minimize side effects 2
- Duration: Limit parenteral use to 1-2 days when possible 1
Dose Adjustments for Special Populations
Renal Impairment
- For patients with creatinine clearance below 40 mL/min, start with approximately half the recommended dose 2
- Metoclopramide is primarily excreted through the kidneys (20% of total clearance) 1
Elderly Patients
- Start with lower doses (5 mg) due to increased risk of side effects 1
- Titrate dose based on response and tolerability 1
Children
Managing Side Effects
Prevention of Extrapyramidal Symptoms
- Consider prophylactic diphenhydramine (25-50 mg) when using higher doses of metoclopramide 1
- Particularly important for high-risk groups: younger patients, females, and those on concomitant antipsychotic therapy 1
Treatment of Extrapyramidal Reactions
- If acute dystonic reactions occur, administer diphenhydramine 25-50 mg IV/IM 2
- Monitor closely for signs of tardive dyskinesia, which increases with longer duration of treatment 1
Important Precautions
- Avoid prolonged use (>5 days) due to increased risk of tardive dyskinesia 3
- The risk of tardive dyskinesia is approximately 0.1% per 1000 patient years 1
- Monitor for neurological side effects, which can be severe and potentially long-lasting even with short-term, low-dose use 4
- Consider alternative antiemetics for patients with history of movement disorders or prolonged metoclopramide use 1
Alternative Antiemetics When Metoclopramide Is Contraindicated
- Ondansetron: 8 mg (sublingual) every 4-6 hours during episode 5
- Promethazine: 12.5-25 mg orally/rectally every 4-6 hours 5
- Prochlorperazine: 5-10 mg every 6-8 hours 5
Metoclopramide remains an effective antiemetic when used appropriately, but careful attention to dosing, duration, and monitoring for side effects is essential to maximize benefit while minimizing risk.