What is the recommended dose of Reglan (metoclopramide)?

Metoclopramide (Reglan) Dosing

The standard dose of metoclopramide is 10 mg orally or intravenously, administered three to four times daily for most indications including nausea, vomiting, and gastroparesis. 1, 2

Standard Dosing by Indication

Nausea and Vomiting

• 10 mg orally or IV, 3-4 times daily is the recommended dose for general nausea and vomiting 1, 2
• For gastroparesis specifically, 10 mg administered 30 minutes before meals and at bedtime (four times daily) is recommended 3
• IV administration should be given slowly over 1-2 minutes when using the 10 mg dose 2

Chemotherapy-Induced Nausea and Vomiting

• For highly emetogenic chemotherapy (cisplatin, dacarbazine): 2 mg/kg IV per dose 2
• For less emetogenic regimens: 1 mg/kg IV per dose 2
• Administer 30 minutes before chemotherapy, repeat every 2 hours for two doses, then every 3 hours for three doses 2
• IV infusions must be given slowly over at least 15 minutes 2

Hiccups

• 5-20 mg orally or IV can be used for hiccup management 4
• May be titrated up to a maximum of 3-4 administrations daily 4

Postoperative Nausea and Vomiting

• 10 mg IM near the end of surgery is the standard dose 2
• Doses of 20 mg may be used in select cases 2

Diagnostic Procedures (Small Bowel Intubation/Radiological Exams)

• Adults and children >14 years: 10 mg IV as single dose 2
• Children 6-14 years: 2.5-5 mg IV 2
• Children <6 years: 0.1 mg/kg IV 2

Dose Adjustments for Renal Impairment

In patients with creatinine clearance below 40 mL/min, initiate therapy at approximately one-half the recommended dosage, then adjust based on clinical response 2. This is critical because metoclopramide is primarily renally excreted 2.

Maximum Duration and Safety Considerations

Duration Limits

• Oral preparations are recommended for 4-12 weeks maximum 5
• Parenteral use should be limited to 1-2 days 5
• For diabetic gastroparesis, IV administration up to 10 days may be required before transitioning to oral therapy 2

Critical Safety Warnings

• Extrapyramidal symptoms and tardive dyskinesia are the most serious adverse effects, though the actual risk is low at approximately 0.1% per 1000 patient-years 6
• High-risk groups include elderly females, diabetics, patients with liver or kidney failure, and those on concurrent antipsychotic medications 6
• If acute dystonic reactions occur, administer 50 mg diphenhydramine IM immediately 2
• Repeated doses can prolong QT interval and precipitate torsades de pointes 4
• Avoid in patients with seizure disorders, pheochromocytoma, GI bleeding, or obstruction 1

Common Pitfalls to Avoid

• Do not exceed recommended doses or duration without compelling clinical justification, as this significantly increases risk of tardive dyskinesia 6
• Do not use as first-line therapy for mild symptoms; reserve for debilitating cases after other remedies have failed 7
• Do not forget dose adjustment in renal impairment, as this is a common cause of adverse effects 2
• The drug has minimal hepatic metabolism, so hepatic impairment requires less dose adjustment than renal impairment 2