What is the typical dosage of Metoclopramide (metoclopramide) for adults and children?

Metoclopramide Dosage

The standard adult dose of metoclopramide is 10 mg administered orally or intravenously three to four times daily, with a maximum daily dose of 30 mg and treatment duration limited to 5 days to minimize the risk of extrapyramidal disorders. 1, 2

Adult Dosing by Indication

Nausea and Vomiting (General)

• 10 mg orally or IV three to four times daily is the standard dose 1, 3
• For refractory cases, can be titrated up to a maximum of 3-4 administrations daily 1
• Maximum daily dose: 30 mg/day 1
• Duration: Limited to 5 days to reduce neurological side effects 4, 1

Diabetic Gastroparesis

• 10 mg administered 30 minutes before meals and at bedtime (four times daily) 1, 2
• If severe symptoms are present, initiate therapy with IV/IM metoclopramide 10 mg slowly over 1-2 minutes 2
• May require up to 10 days of parenteral therapy before transitioning to oral administration 2

Chemotherapy-Induced Nausea and Vomiting (CINV)

• For highly emetogenic chemotherapy (cisplatin, dacarbazine): 2 mg/kg IV 2
• For less emetogenic regimens: 1 mg/kg IV 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

Postoperative Nausea and Vomiting

• 10 mg IM near the end of surgery 2
• Doses of 20 mg may be used 2

Hiccups

• 5-20 mg orally or IV 5
• Can be titrated up to a maximum of 3-4 administrations daily 5

Pediatric Dosing

General Considerations

• For children >14 years: 10 mg (adult dosing) 2
• For children 6-14 years: 2.5-5 mg 2
• For children <6 years: 0.1 mg/kg 2

Chemotherapy-Induced Nausea and Vomiting in Children

• Doses of 2 mg/kg or higher are associated with increased risk of extrapyramidal reactions (15%) and akathisia (33%) 6
• Doses less than 2 mg/kg have minimal toxicity 6
• Concomitant diphenhydramine should be administered to reduce extrapyramidal reactions 6
• Children receiving two consecutive days of metoclopramide have higher frequency of extrapyramidal symptoms 6

Special Populations

Renal Impairment

• For creatinine clearance <40 mL/min: Initiate at approximately one-half the recommended dosage 2
• Adjust dose based on clinical efficacy and safety 2

Hepatic Impairment

• Metoclopramide undergoes minimal hepatic metabolism 2
• Safe use has been described in patients with advanced liver disease and normal renal function 2

Elderly Patients

• Patients >59 years may require dose reduction (based on streptomycin dosing principles for age-related considerations) 4
• Increased caution warranted due to higher risk of adverse effects 5

Critical Safety Considerations

Maximum Dose and Duration Restrictions

• Absolute maximum: 30 mg/day 1
• Maximum duration: 5 days 4, 1
• These restrictions were implemented by the European Medicines Agency to minimize risk of extrapyramidal disorders and tardive dyskinesia 4, 1

Extrapyramidal Symptoms Management

• If acute dystonic reactions occur: Inject 50 mg diphenhydramine IM immediately 2
• Symptoms usually subside rapidly with diphenhydramine 2
• Extrapyramidal symptoms occur in approximately 9% of pediatric patients 7

Contraindications and Precautions

• Avoid in patients with seizure disorders or pheochromocytoma 1
• Use with caution in GI bleeding or obstruction 1
• Repeated doses can potentially prolong QT interval and precipitate torsades de pointes 5
• Caution in patients with impaired renal or hepatic function, elderly, and those with CNS depression 5

Administration Routes

Intravenous Administration

• For doses >10 mg, dilute in 50 mL of parenteral solution 2
• Preferred solution: Normal saline (can be stored frozen for up to 4 weeks) 2
• Administer slowly over 1-2 minutes for standard doses 2
• For CINV: Infuse over at least 15 minutes 2

Oral Administration

• Standard tablets: 5-20 mg per dose 1
• Administer 30 minutes before meals for gastroparesis 1, 2

Intramuscular Administration

• 10 mg IM for postoperative nausea and vomiting 2
• Can be combined with diphenhydramine 25 mg IM 8

Common Pitfalls to Avoid

• Do not exceed 30 mg/day or 5 days duration - this significantly increases risk of tardive dyskinesia and extrapyramidal disorders 4, 1
• Do not use as first-line therapy - reserve for debilitating cases after other remedies have been tried 8
• Do not ignore early neurological symptoms - even low-dose, short-term use (30 mg total over 3 days) can cause severe, long-lasting adverse effects lasting up to 13 months 8
• Do not assume dose-responsiveness - there is no evidence of dose-responsiveness for anti-nausea effects with standard dosing regimens 9
• Do not use intermediate doses (0.4 mg/kg) expecting better efficacy - studies show no difference in effectiveness compared to standard 10 mg dosing 10