What is the recommended dosage of Maxolon (metoclopramide) for treating nausea and vomiting?

Maxolon (Metoclopramide) Dosage

For nausea and vomiting, the standard adult dose of metoclopramide is 10 mg orally or intravenously, administered 3-4 times daily, 30 minutes before meals and at bedtime. 1, 2

Standard Dosing Regimens

Oral Administration

• 10 mg orally 3-4 times daily (30 minutes before meals and at bedtime) for general nausea and vomiting 1, 2
• Maximum daily dose: 40 mg per day in divided doses 2

Intravenous/Intramuscular Administration

• 10 mg IV or IM administered slowly over 1-2 minutes 2
• Can be repeated every 6-8 hours as needed 2
• For severe symptoms, IV/IM route should be used initially, then transition to oral once symptoms improve 2

Specific Clinical Scenarios

Diabetic Gastroparesis

• 10 mg orally or IV administered 30 minutes before meals and at bedtime 2
• If severe symptoms are present, begin with IV/IM administration for up to 10 days, then transition to oral 2
• Treatment duration should be reassessed regularly due to risk of tardive dyskinesia with prolonged use 2

Chemotherapy-Induced Nausea (High-Dose Regimen)

• 2 mg/kg IV for highly emetogenic chemotherapy (cisplatin, dacarbazine) 2
• 1 mg/kg IV for less emetogenic regimens 2
• Administer slowly over at least 15 minutes, 30 minutes before chemotherapy 2
• Repeat every 2 hours for two doses, then every 3 hours for three doses 2
• Important caveat: Metoclopramide is less effective than ondansetron for chemotherapy-induced nausea and should not be first-line 3

Postoperative Nausea

• 10 mg IM administered near the end of surgery 2
• 20 mg IM may be used for more severe cases 2

Dose Adjustments

Renal Impairment

• Reduce dose by 50% when creatinine clearance is below 40 mL/min 2
• Titrate based on clinical response and tolerability 2

Hepatic Impairment

• Minimal dose adjustment needed as metoclopramide undergoes minimal hepatic metabolism 2
• Use standard dosing in patients with liver disease and normal renal function 2

Critical Safety Considerations

Duration of Treatment

• Limit treatment to 12 weeks maximum due to risk of tardive dyskinesia, which increases with duration of use 2, 4
• Reassess need for continued therapy regularly 2

Serious Adverse Effects

• Tardive dyskinesia can occur even with short-term, low-dose use and may persist for months after discontinuation 4
• Extrapyramidal symptoms (dystonia, akathisia) can occur, particularly in young adults 4, 5
• If acute dystonic reactions occur, administer 50 mg diphenhydramine IM immediately 2

Comparative Effectiveness

• Metoclopramide is significantly less effective than ondansetron for chemotherapy-induced nausea (41% vs 65% complete protection) 3
• For postoperative nausea, metoclopramide has modest efficacy with number-needed-to-treat of 9.1 for early vomiting and 10 for late vomiting 5
• Higher doses (0.4 mg/kg) are not more effective than standard 10 mg doses for general nausea and vomiting 6

Gender Considerations

• Metoclopramide may be more effective in women than men for diabetic gastroparesis, with significant symptom reduction only observed in female patients 7

Common Pitfalls to Avoid

• Do not use metoclopramide as first-line for chemotherapy-induced nausea when 5-HT3 antagonists (ondansetron) are available, as they are significantly more effective 3
• Do not exceed 10 mg per dose for routine nausea, as higher doses do not improve efficacy but may increase adverse effects 6
• Do not continue treatment beyond 12 weeks without compelling indication due to cumulative risk of tardive dyskinesia 2, 4
• Reserve metoclopramide for debilitating cases after other remedies have been tried, given the risk of serious neurological adverse effects 4