What is the recommended dosing for Maxeran (Metoclopramide)?

Maxeran (Metoclopramide) Dosing

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

Standard Dosing by Indication

Nausea and Vomiting (General)

• 10 mg orally or IV three to four times daily is the recommended dose for acute nausea and vomiting 1
• Maximum daily dose should not exceed 30 mg/day 1
• Treatment duration should be restricted to 5 days or less to reduce neurological risks 1

Diabetic Gastroparesis

• 10 mg administered 30 minutes before meals and at bedtime (four times daily) 1
• For severe symptoms, initiate with 10 mg IM or IV slowly over 1-2 minutes, then transition to oral therapy once symptoms improve 2
• Treatment may require up to 10 days of parenteral administration before oral therapy can begin 2

Migraine-Associated Nausea

• 10 mg orally or IV as adjunctive therapy when nausea accompanies migraine 1
• Can be combined with other migraine-specific treatments 3

Chemotherapy-Induced Nausea and Vomiting (CINV)

• For highly emetogenic chemotherapy (cisplatin, dacarbazine): 2 mg/kg IV infused slowly over at least 15 minutes 2
• For less emetogenic regimens: 1 mg/kg per dose may be adequate 2
• Administer 30 minutes before chemotherapy, repeat every 2 hours for two doses, then every 3 hours for three doses 2
• Note: High-dose metoclopramide (≥2 mg/kg) in children carries a 15% risk of extrapyramidal reactions and 33% risk of akathisia 4

Postoperative Nausea and Vomiting

• 10 mg IM administered near the end of surgery 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 undiluted over 1-2 minutes 2
• Children 6-14 years: 2.5-5 mg IV 2
• Children <6 years: 0.1 mg/kg IV 2

Administration Routes and Formulations

• Oral tablets: 5-20 mg per dose 1
• Intravenous: Administer slowly over 1-2 minutes for standard doses; infuse over at least 15 minutes for high-dose chemotherapy regimens 2
• Intramuscular: Available for postoperative use and severe gastroparesis 2

Critical Safety Considerations

Duration and Dose Restrictions

• Maximum treatment duration: 5 days to minimize risk of tardive dyskinesia and extrapyramidal disorders 1
• Maximum daily dose: 30 mg across all indications 1
• The European Medicines Agency specifically emphasizes these restrictions to reduce neurological complications 1

Extrapyramidal Reactions

• If acute dystonic reactions occur, administer 50 mg diphenhydramine IM immediately; symptoms usually subside rapidly 2
• Younger patients have increased susceptibility to extrapyramidal symptoms 5, 4
• Consecutive days of high-dose therapy increase the frequency of extrapyramidal reactions 4

Contraindications and Precautions

• Avoid in: Seizure disorders, pheochromocytoma, GI bleeding or obstruction 1
• Use with caution in: Elderly patients (may require dose reduction), patients with renal impairment 1, 2

Renal Impairment Dosing

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

Common Pitfalls to Avoid

• Do not exceed 5 days of treatment unless absolutely necessary, as prolonged use significantly increases risk of tardive dyskinesia 1
• Do not use as first-line therapy for simple nausea when other remedies have not been tried, particularly given reports of severe long-lasting adverse effects even with short-term low-dose use 6
• Monitor closely in children receiving high-dose regimens (≥2 mg/kg), as they have higher rates of extrapyramidal symptoms 4
• Most common reversible adverse effects include restlessness, drowsiness, fatigue, sedation, and diarrhea 5, 7