Administration Protocol for IV Reglan (Metoclopramide)
For intravenous administration of Reglan (metoclopramide), administer 10 mg slowly over 1-2 minutes for most indications, with specific protocols required for chemotherapy-induced nausea and vomiting. 1
Standard IV Administration Protocol
- For most indications (gastroparesis, facilitating small bowel intubation, radiological examinations), administer 10 mg doses slowly over a 1-2 minute period 1
- Ensure proper patient identification and appropriate vascular access before administration 2
- Have emergency medications (such as diphenhydramine) readily available to treat potential extrapyramidal reactions 1
- Monitor vital signs before, during, and after administration 2
Specific Dosing Guidelines by Indication
Diabetic Gastroparesis
- Administer 10 mg slowly IV over 1-2 minutes 1
- May continue administration for up to 10 days before transitioning to oral therapy 1
- For patients with renal impairment (creatinine clearance <40 mL/min), start with approximately half the recommended dose 1
Prevention of Chemotherapy-Induced Nausea and Vomiting
- Administer as an infusion over at least 15 minutes, 30 minutes before chemotherapy 1
- Initial dose: 1-2 mg/kg depending on emetogenic potential of chemotherapy regimen 1
- For highly emetogenic drugs (cisplatin, dacarbazine), use 2 mg/kg per dose 1
- For less emetogenic regimens, 1 mg/kg per dose may be adequate 1
- Repeat every 2 hours for two doses, then every 3 hours for three doses 1
- For doses exceeding 10 mg, dilute in 50 mL of parenteral solution 1
Prevention of Postoperative Nausea and Vomiting
To Facilitate Small Bowel Intubation or Radiological Examinations
- Adults and children >14 years: 10 mg IV over 1-2 minutes 1
- Children 6-14 years: 2.5-5 mg IV 1
- Children <6 years: 0.1 mg/kg IV 1
Dilution and Compatibility
- For doses >10 mg, dilute in 50 mL of parenteral solution 1
- Preferred diluent is Sodium Chloride Injection (normal saline) 1
- When diluted in normal saline, can be stored frozen for up to 4 weeks 1
- Avoid dilution with Dextrose-5% in Water if planning to freeze the solution 1
- Metoclopramide is incompatible with several medications including diazepam, ketamine, lorazepam, nitroglycerin, phenytoin, and propofol during Y-site administration 3
Special Considerations
- For patients with renal impairment (creatinine clearance <40 mL/min), start with approximately half the recommended dose 1
- Metoclopramide undergoes minimal hepatic metabolism and can be used in patients with advanced liver disease who have normal renal function 1
- Parenteral metoclopramide use should generally be limited to 1-2 days 4
- Monitor closely for extrapyramidal symptoms, especially in younger patients and with higher doses 5
Management of Adverse Reactions
- For acute dystonic reactions, administer 50 mg diphenhydramine intramuscularly 1
- The most common adverse reactions include restlessness, drowsiness, fatigue, and lassitude 4
- Extrapyramidal symptoms occur more frequently with high doses (≥2 mg/kg) or prolonged use 5
- Children receiving doses ≥2 mg/kg have shown a 15% incidence of extrapyramidal reactions and 33% incidence of akathisia 5
Common Pitfalls to Avoid
- Never administer IV metoclopramide rapidly as a bolus, as this increases the risk of adverse reactions 2, 1
- Avoid prolonged use of parenteral metoclopramide (limit to 1-2 days when possible) 4
- Be aware that children and young adults have an increased risk of extrapyramidal reactions 5
- Ensure proper dilution for doses exceeding 10 mg 1
- Verify compatibility when administering with other medications 3