Metoclopramide Injection Dosing for a 10-Year-Old Child
For a 10-year-old child, the recommended dosage of metoclopramide injection is 0.1 mg/kg per dose, which should not exceed 10 mg per single dose.
Dosing Guidelines
The FDA-approved dosing for metoclopramide injection in pediatric patients varies by indication:
For small bowel intubation facilitation 1:
- Children 6-14 years: 2.5-5 mg metoclopramide base
- Children under 6 years: 0.1 mg/kg metoclopramide base
For antiemetic purposes 2:
- The maximum daily dose should not exceed 0.5 mg/kg/day
- Typically administered every 6-8 hours as needed
Administration Considerations
- Administer intravenous doses slowly over 1-2 minutes to minimize side effects 1
- For IV infusions, metoclopramide should be diluted in an appropriate parenteral solution
- Sodium Chloride Injection (normal saline) is the preferred diluent 1
Duration of Treatment
- Parenteral metoclopramide should be limited to 1-2 days when possible 2, 3
- Transition to oral formulation once the patient can tolerate oral medications
Safety Considerations and Monitoring
Adverse Effects
Metoclopramide carries significant risk of adverse effects in children, with the most common being:
- Extrapyramidal symptoms (EPS) - incidence as high as 9-25% in children 4, 5
- Sedation - approximately 6% in multiple-dose studies 4
- Diarrhea - approximately 6% 4
Risk Factors and Precautions
- Age restrictions: Some regulatory agencies contraindicate use in children <1 year and caution against use in children <5 years 4
- Duration: Limit treatment duration to minimize risk of tardive dyskinesia 2
- Renal impairment: For patients with creatinine clearance below 40 mL/min, reduce dose by approximately 50% 2, 1
Management of Adverse Effects
- If acute dystonic reactions occur, administer diphenhydramine 50 mg intramuscularly 1
- Discontinue metoclopramide immediately if extrapyramidal symptoms develop 5, 6
Important Warnings
- Even at recommended doses, children may experience significant adverse effects 5, 6
- Extrapyramidal symptoms can mimic other serious conditions such as encephalitis or tetany 5
- Long-lasting adverse effects have been reported even after short-term, low-dose treatment 7
Clinical Decision Making
When considering metoclopramide for a 10-year-old:
- Ensure other antiemetics with better safety profiles have been considered first
- Calculate the appropriate weight-based dose (0.1 mg/kg)
- Do not exceed 10 mg per single dose
- Monitor closely for extrapyramidal symptoms during and after administration
- Limit duration of parenteral therapy to 1-2 days when possible
Remember that metoclopramide should be used cautiously in pediatric patients due to the higher risk of extrapyramidal side effects in this population.