Recommended Frequency for IV Metoclopramide Administration
For intravenous metoclopramide administration, the recommended frequency is every 4 to 6 hours as needed for nausea and vomiting. 1
Dosing Guidelines by Indication
For Chemotherapy-Induced Nausea and Vomiting
- For prevention of nausea and vomiting with highly emetogenic chemotherapy: 2 mg/kg IV every 2 hours for two doses, then every 3 hours for three doses 2
- For less emetogenic regimens: 1 mg/kg IV per dose may be adequate 2
- IV infusions should be administered slowly over at least 15 minutes, starting 30 minutes before beginning chemotherapy 2
For Breakthrough Nausea and Vomiting
- 10-40 mg IV either every 4 or every 6 hours as needed 1
- For persistent symptoms, consider administering on a scheduled basis rather than PRN 1
For Diabetic Gastroparesis
- 10 mg IV administered slowly over 1-2 minutes 2
- May be given for up to 10 days until symptoms subside, at which point oral administration can be initiated 2
For Postoperative Nausea and Vomiting
- 10 mg IV as a single dose (up to 20 mg may be used) 2
- Administered intramuscularly near the end of surgery 2
Administration Considerations
- For doses exceeding 10 mg, metoclopramide should be diluted in 50 mL of parenteral solution 2
- Preferred diluent is Sodium Chloride Injection (normal saline), which when combined with metoclopramide can be stored frozen for up to 4 weeks 2
- IV administration should be done slowly:
Special Populations
Renal Impairment
- For patients with creatinine clearance below 40 mL/min, initiate therapy at approximately half the recommended dosage 2
- Adjust dose based on clinical efficacy and safety considerations 2
Pediatric Patients
- For children receiving highly emetogenic chemotherapy, doses of 2 mg/kg IV every two hours for four doses have shown promising efficacy 3
- For facilitation of small bowel intubation:
Monitoring and Management of Side Effects
- Monitor for extrapyramidal reactions, particularly with higher doses (≥2 mg/kg) 3
- If acute dystonic reactions occur, administer 50 mg diphenhydramine intramuscularly 2
- Consecutive days of treatment may increase risk of extrapyramidal reactions 3
Comparative Efficacy
- IV metoclopramide shows superior efficacy for rapid gastric emptying compared to oral administration 4
- For chemotherapy-induced nausea and vomiting, high-dose oral and IV regimens have shown equivalent antiemetic efficacy in some studies 5
Remember that metoclopramide is generally not intended for long-term use, with parenteral therapy typically limited to 1-2 days 6.