Is there an oral form of Reglan (metoclopramide)?

Is There an Oral Form of Reglan (Metoclopramide)?

Yes, metoclopramide (Reglan) is available in oral formulations including tablets and oral solution, in addition to injectable forms. 1

Available Formulations

Metoclopramide comes in multiple administration routes:

• Oral tablets: Standard formulation available in various strengths (typically 5 mg and 10 mg tablets) 1
• Oral solution: Liquid formulation for patients who cannot swallow tablets 1
• Injectable forms: Intravenous (IV) and intramuscular (IM) preparations 1
• Nasal spray: A newer formulation that has shown superior efficacy compared to oral tablets in diabetic gastroparesis 2

Oral Dosing Guidelines

The standard oral dosing varies by indication:

• Nausea and vomiting: 10 mg orally three to four times daily 3
• Diabetic gastroparesis: 10 mg administered 30 minutes before meals and at bedtime (four times daily) 3
• Hiccups: 5-20 mg orally, with titration up to a maximum of 3-4 administrations daily 4

Pharmacokinetic Considerations

The oral formulation has excellent bioavailability at 80% ± 15.5%, making it highly effective when gastrointestinal absorption is intact. 1

Key pharmacokinetic properties of oral metoclopramide:

• Onset of action: 30-60 minutes after oral administration (compared to 1-3 minutes IV) 1
• Peak plasma concentrations: Occur at 1-2 hours after oral dosing 1
• Duration of effect: Pharmacological effects persist for 1-2 hours 1
• Half-life: 5-6 hours in patients with normal renal function 1

Critical Safety Limitations

Treatment duration should be limited to short-term use (up to 5 days) with a maximum daily dose of 30 mg to minimize the risk of serious neurological adverse effects, particularly tardive dyskinesia. 3

Important safety considerations:

• FDA black box warning: Prolonged use (>12 weeks) carries significant risk of extrapyramidal symptoms including tardive dyskinesia, which may be irreversible 5
• Dose adjustment required: In patients with creatinine clearance below 40 mL/min, initiate therapy at approximately one-half the recommended dosage 1
• Elderly patients: May require dose reduction due to higher risk of adverse effects 3

When to Choose Oral vs. IV Administration

Oral metoclopramide should be initiated when only early manifestations of symptoms are present; severe symptoms require IV or IM administration initially. 1

The FDA label specifies:

• For diabetic gastroparesis with severe symptoms: Begin with IV/IM injection, then transition to oral once symptoms subside (may require up to 10 days of parenteral therapy) 1
• For cancer chemotherapy-induced emesis: IV infusion is preferred due to severity of symptoms 1
• Both routes demonstrate similar efficacy when gastrointestinal absorption is intact 4

Common Pitfalls to Avoid

• Do not use oral formulation in patients with severe gastroparesis or impaired GI absorption, as bioavailability will be compromised 1
• Avoid exceeding 30 mg daily or 5 days duration to prevent serious neurological complications 3
• Do not prescribe in patients with seizure disorders, pheochromocytoma, GI bleeding, or GI obstruction 5, 4
• Monitor for extrapyramidal symptoms (dystonic reactions, akathisia, parkinsonism) even with short-term use, as severe reactions can occur after low-dose administration 6