Recommended IV Metoclopramide Dose for Children
The recommended intravenous dose of metoclopramide in children is 0.1 mg/kg every 6 hours, with a maximum single dose not exceeding 10 mg. 1
Standard Dosing Parameters
Initial dose: 0.1 mg/kg IV every 6 hours is the evidence-based starting point that achieves therapeutic exposure for most pediatric indications while minimizing adverse effects 1
Alternative dosing: 0.15 mg/kg IV every 6 hours may be considered in select cases, though this increases exposure and potentially adverse effect risk 1
Maximum single dose: Do not exceed 10 mg per dose regardless of weight-based calculation
Critical Safety Considerations
Extrapyramidal Symptoms (EPS) Risk
EPS occurs in approximately 9% of pediatric patients receiving metoclopramide, making it the most common adverse effect 2
Higher risk scenarios that substantially increase EPS incidence include:
Prophylactic diphenhydramine (1-2 mg/kg or 25-50 mg parenterally) should be strongly considered when using metoclopramide, especially at higher doses or with repeated administration 6, 3, 4
Age-Specific Warnings
Contraindicated in infants <1 year per regulatory guidance from Canadian and EU drug agencies 2
Use with extreme caution in children <5 years, as this population demonstrates increased susceptibility to extrapyramidal reactions 2
Duration Limitations
- Do not exceed 5 days of continuous therapy to minimize risk of tardive dyskinesia and cumulative toxicity 2
Management of Acute Dystonic Reactions
If EPS or acute dystonic reactions occur:
Administer diphenhydramine immediately: 1-2 mg/kg or 25-50 mg parenterally 6
Reactions are rapidly reversible with diphenhydramine treatment, typically resolving within minutes 4
Clinical Context
The 0.1 mg/kg dose achieves steady-state concentrations within the therapeutic range for gastroesophageal reflux treatment in >75% of pediatric patients, though slightly lower exposures may occur in children <2 years 1. Historical studies using 2 mg/kg doses for chemotherapy-induced nausea showed efficacy but unacceptably high toxicity rates (15% EPS, 33% akathisia), making such high doses inappropriate for routine use 3.