Metoclopramide Injection Dosage for Nausea, Vomiting, and Gastroparesis
For gastroparesis and nausea/vomiting, metoclopramide injection should be administered at 10 mg intramuscularly or intravenously (given slowly over 1-2 minutes) every 6 hours, with intravenous administration preferred for severe symptoms. 1
Dosing Guidelines for Different Indications
Diabetic Gastroparesis
- Initial treatment for severe symptoms:
- 10 mg IV (administered slowly over 1-2 minutes) or IM every 6 hours
- May require up to 10 days of parenteral therapy before transitioning to oral administration
- Oral dosing: 5-20 mg three to four times daily 2
Nausea and Vomiting (General)
- Standard dosing: 10 mg IM or IV every 6 hours
Chemotherapy-Induced Nausea and Vomiting
- Administration: IV infusion over at least 15 minutes, 30 minutes before chemotherapy
- Dosing schedule: Repeat every 2 hours for two doses, then every 3 hours for three doses
- Dosage:
- 2 mg/kg for highly emetogenic regimens (cisplatin, dacarbazine)
- 1 mg/kg for less emetogenic regimens
- For doses >10 mg, dilute in 50 mL normal saline 1
Postoperative Nausea and Vomiting
- Timing: Near the end of surgery
- Dosage: 10 mg IM (may use up to 20 mg) 1
Special Populations
Renal Impairment
- For patients with creatinine clearance <40 mL/min, start with approximately half the recommended dose
- Titrate based on efficacy and safety 1
Hepatic Impairment
- No specific dose adjustment needed for patients with advanced liver disease if renal function is normal 1
Administration Considerations
IV Administration
- Administer slowly over 1-2 minutes for direct IV push
- For infusions, dilute in 50 mL of normal saline (preferred) or other compatible solutions
- Diluted solutions can be stored:
- Up to 4 weeks when frozen in normal saline
- Up to 48 hours refrigerated (protected from light)
- Up to 24 hours at room temperature under normal light conditions 1
Compatibility
- Compatible with normal saline, Dextrose-5% in Water, Dextrose-5% in 0.45% Sodium Chloride, Ringer's Injection, and Lactated Ringer's Injection
- Avoid freezing when mixed with Dextrose-5% in Water 1
Important Considerations
Duration of Treatment
- FDA recommends limiting treatment duration due to risk of tardive dyskinesia
- For gastroparesis, treatment beyond 12 weeks requires thorough risk-benefit assessment 3
Management of Acute Dystonic Reactions
- If acute dystonic reactions occur, administer diphenhydramine 50 mg IM 1
Monitoring
- Monitor for extrapyramidal symptoms, especially with prolonged use
- Metoclopramide is the only FDA-approved medication for gastroparesis; all other agents are considered off-label 2
Remember that metoclopramide works by enhancing upper gastrointestinal motility and has both prokinetic and antiemetic properties, making it effective for both the delayed gastric emptying and the nausea/vomiting symptoms associated with gastroparesis.