What is the recommended dose of Reglan (metoclopramide) for nausea?

Metoclopramide Dosing for Nausea

For general nausea in adults, metoclopramide 10 mg orally or intravenously is the standard recommended dose, administered every 6-8 hours as needed, with a maximum of 3-4 doses per 24 hours. 1, 2

Standard Dosing Regimens by Clinical Context

General Nausea (Non-Chemotherapy Related)

• 10 mg orally or IV administered 20-30 minutes before meals and at bedtime for optimal effect 1, 2
• Can be repeated every 6-8 hours as needed 1
• Maximum daily dosing should not exceed 3-4 administrations 1

Opioid-Induced Nausea

• First-line agent: 10-20 mg orally multiple times daily 1
• Metoclopramide has both central and peripheral antiemetic effects, making it particularly effective for chronic nausea including opioid-related causes 1
• For prophylaxis in patients with prior opioid-induced nausea, administer around-the-clock for the first few days, then transition to as-needed dosing 1

Migraine-Associated Nausea

• 10 mg IV or orally given 20-30 minutes before or with analgesics 1
• Particularly useful when gastric motility is impaired during migraine attacks 1

Chemotherapy-Induced Nausea (High-Dose Regimen)

• 1-2 mg/kg IV infused slowly over at least 15 minutes 2
• Administer 30 minutes before chemotherapy, repeat every 2 hours for two doses, then every 3 hours for three doses 2
• For highly emetogenic drugs (cisplatin, dacarbazine): use 2 mg/kg per dose 2
• For less emetogenic regimens: 1 mg/kg per dose may be adequate 2

Route of Administration Considerations

Intravenous administration should be used when:

• Oral route is compromised by severe nausea/vomiting 2
• Rapid onset is required 2
• Gastric emptying is significantly delayed 3

IV administration technique: Administer slowly over 1-2 minutes for doses up to 10 mg; doses exceeding 10 mg should be diluted in 50 mL parenteral solution and infused over at least 15 minutes 2

Critical Dosing Adjustments

Renal Impairment

• Creatinine clearance <40 mL/min: Reduce dose by approximately 50% 2
• Metoclopramide is excreted principally through the kidneys, making dose reduction essential to prevent toxicity 2

Hepatic Impairment

• Metoclopramide undergoes minimal hepatic metabolism; standard dosing can be used if renal function is normal 2

Important Safety Considerations and Contraindications

Absolute Contraindications

• Pheochromocytoma 1, 4
• Seizure disorders 1, 4
• GI bleeding or obstruction 1, 4

Common Adverse Effects

• Extrapyramidal symptoms (EPS): Occur in approximately 9% of pediatric patients and are dose-related 5
• Restlessness, drowsiness, diarrhea, and muscle weakness 1
• Dystonic reactions: Treat immediately with diphenhydramine 50 mg IM 2

Serious but Rare Adverse Effects

• Prolonged QT interval and potential for torsades de pointes with repeated dosing 4
• Tardive dyskinesia with chronic use 1
• Long-lasting adverse effects have been reported even after short-term, low-dose use (5-10 mg daily for 3 days), including involuntary movements persisting for months 6

Clinical Pearls and Pitfalls

Duration of therapy: Limit use to the shortest duration necessary; regulatory agencies caution against use beyond 5 days in children and recommend similar caution in adults 5

Gender considerations: Metoclopramide nasal spray demonstrated efficacy in women with diabetic gastroparesis but not in men, suggesting sex may influence treatment response 3

Continuous vs. intermittent dosing: For severe chemotherapy-induced nausea, continuous infusion (1 mg/kg bolus followed by 0.5 mg/kg/h for 10 hours) provides superior control with fewer adverse effects compared to intermittent boluses 7

Avoid in elderly and those with CNS depression: Exercise particular caution as these populations are at higher risk for adverse effects 1, 4