When is Reglan (metoclopramide) administered?

Indications for Reglan (Metoclopramide) Administration

Reglan (metoclopramide) should be administered for gastroparesis, chemotherapy-induced nausea and vomiting, postoperative nausea and vomiting, intractable hiccups, and to facilitate small bowel intubation for radiological procedures. 1, 2

Primary Indications

• Diabetic Gastroparesis: Metoclopramide 5-10 mg PO QID, 30 minutes before meals and at bedtime, is indicated for gastroparesis to accelerate gastric emptying 1, 2
• Chemotherapy-Induced Nausea and Vomiting: Administered 30 minutes before chemotherapy and repeated every 2-3 hours, typically at doses of 1-2 mg/kg IV depending on the emetogenic potential of the chemotherapy regimen 2
• Postoperative Nausea and Vomiting: Given intramuscularly near the end of surgery at a dose of 10 mg (up to 20 mg in some cases) 2
• Facilitation of Small Bowel Intubation: Administered if the tube hasn't passed the pylorus with conventional maneuvers within 10 minutes, at doses of 10 mg IV for adults 2
• Radiological Examinations: Used when delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine 2

Secondary Indications

• Pregnancy-Related Nausea and Vomiting: Recommended as a second-line therapy for hyperemesis gravidarum after first-line treatments (vitamin B6, doxylamine) have failed 1
• Intractable Hiccups: Administered at 10 mg orally three to four times daily to address potential gastroesophageal reflux that may trigger hiccups 3

Dosing Considerations

• Renal Impairment: For patients with creatinine clearance below 40 mL/min, therapy should be initiated at approximately half the recommended dosage 2
• Duration of Therapy:
  • Oral preparations are recommended for 4-12 weeks of therapy 4
  • Parenteral metoclopramide should be limited to 1-2 days when possible 4

Monitoring and Precautions

• Extrapyramidal Symptoms: Monitor for dystonic reactions, akathisia, and tardive dyskinesia, especially with high doses or prolonged use 3, 4
• Drug Interactions: Should not be given in combination with MAO inhibitors, tricyclic antidepressants, or sympathomimetic amines 5
• Contraindications: Avoid in patients with pheochromocytoma, GI hemorrhage, obstruction, or perforation 5
• Management of Adverse Effects: If acute dystonic reactions occur, administer 50 mg diphenhydramine intramuscularly 2

Special Considerations

• Pregnancy: No increased risk of congenital defects has been reported with metoclopramide use during pregnancy 1
• Adverse Effects: Common side effects include restlessness, drowsiness, fatigue, and lassitude 4
• Severe Reactions: Though rare, severe and long-lasting adverse effects can occur even after short-term, low-dose administration 6

Treatment Algorithm

1. First-line for gastroparesis: Start with 10 mg PO QID, 30 minutes before meals and at bedtime 1
2. For severe symptoms: Begin with injectable form (IM or IV) before transitioning to oral administration 2
3. For chemotherapy-induced nausea: Administer IV 30 minutes before chemotherapy, with dosage based on emetogenic potential 2
4. For pregnancy-related nausea: Use only after first-line treatments have failed 1
5. Limit duration: Restrict to shortest effective period to minimize risk of tardive dyskinesia 3, 4