What is the recommended dose and frequency for Reglan (metoclopramide)?

Metoclopramide Dosing and Administration Guidelines

The recommended dose of metoclopramide for adults is 10 mg orally or intravenously three to four times daily, with adjustments based on indication, patient factors, and duration limitations due to risk of adverse effects. 1

Standard Dosing by Indication

Diabetic Gastroparesis

• Initial dose: 10 mg orally three to four times daily, 30 minutes before meals and at bedtime 1
• For severe symptoms, therapy may begin with injectable metoclopramide (IM or IV) administered slowly over 1-2 minutes 1
• Treatment duration: Up to 10 days may be required before symptoms subside, after which oral administration can be instituted 1

Nausea and Vomiting (General)

• Standard dose: 10 mg orally or IV three to four times daily 2
• For adjunctive therapy in migraine with nausea: 10 mg IV or orally 20-30 minutes before or with analgesics 2
• For refractory nausea and vomiting: Can be titrated up to a maximum of 3-4 administrations daily 2

Chemotherapy-Induced Nausea and Vomiting

• For highly emetogenic chemotherapy: 2 mg/kg IV 30 minutes before chemotherapy, repeated every 2 hours for two doses, then every 3 hours for three doses 1
• For less emetogenic regimens: 1 mg/kg per dose may be adequate 1
• IV infusions should be administered slowly over at least 15 minutes 1

Postoperative Nausea and Vomiting

• Standard dose: 10 mg IM near the end of surgery 1
• In some cases, doses of 20 mg may be used 1

To Facilitate Small Bowel Intubation or Radiological Examinations

• Adults: 10 mg IV administered slowly over 1-2 minutes 1
• Pediatric patients (6-14 years): 2.5-5 mg IV 1
• Pediatric patients (under 6 years): 0.1 mg/kg IV 1

Dose Adjustments for Special Populations

Renal Impairment

• For patients with creatinine clearance below 40 mL/min: Start with approximately half the recommended dosage 1
• Dose may be increased or decreased based on clinical efficacy and safety considerations 1

Hepatic Impairment

• No specific dose adjustment required for hepatic impairment as metoclopramide undergoes minimal hepatic metabolism 1
• Safe use has been described in patients with advanced liver disease who have normal renal function 1

Elderly Patients

• Lower doses may be appropriate due to increased risk of adverse effects 3
• Start with the lower end of the dosing range and titrate as needed 3

Administration Routes and Considerations

Oral Administration

• Standard tablets: 5-20 mg per dose 2
• Administer 30 minutes before meals and at bedtime 1

Intravenous Administration

• Administer doses of 10 mg slowly over 1-2 minutes 1
• For chemotherapy-induced nausea and vomiting, infuse slowly over at least 15 minutes 1
• For doses exceeding 10 mg, dilute in 50 mL of parenteral solution (preferably normal saline) 1

Intramuscular Administration

• 10 mg per dose, particularly useful for postoperative nausea and vomiting 1

Subcutaneous Administration

• 10 mg every 6 hours has shown efficacy in treating gastroparesis in outpatient settings 4

Duration of Treatment and Safety Considerations

• Important safety limitation: Metoclopramide is generally not intended for long-term use 5
• Oral preparations are recommended for 4-12 weeks of therapy maximum 5
• Parenteral metoclopramide should be limited to 1-2 days when possible 5
• Monitor for extrapyramidal symptoms, which occur rarely with short-term use but risk increases with high dosage or prolonged use 5, 3
• If acute dystonic reactions occur, administer 50 mg diphenhydramine intramuscularly 1

Common Adverse Effects to Monitor

• Most common: Restlessness, drowsiness, fatigue, and lassitude 5
• More serious: Extrapyramidal symptoms and dystonic reactions 5, 3
• Rare but reported: Long-lasting adverse effects including involuntary movements even after short-term, low-dose use 3

Key Precautions

• Administer IV doses slowly to minimize risk of extrapyramidal effects 6
• Avoid use in patients with seizure disorders or pheochromocytoma 2
• Use with caution in patients with GI bleeding or obstruction 2
• Consider as second-line therapy in pregnancy due to risk of extrapyramidal effects 6

Remember that metoclopramide is the only FDA-approved medication for gastroparesis, but its use should be carefully monitored due to potential adverse effects 2.