Metoclopramide Dosing for a 12-Year-Old Female
For a 12-year-old female, administer metoclopramide 0.1 mg/kg IV or IM (maximum 10 mg per dose) every 6-8 hours as needed for nausea and vomiting, with treatment limited to 5 days maximum to minimize serious neurological risks. 1, 2
Weight-Based Pediatric Dosing
- The standard pediatric dose is 0.1 mg/kg per dose, which can be given intramuscularly or intravenously 1
- For a typical 12-year-old weighing approximately 40 kg, this translates to 4 mg per dose
- Maximum single dose should not exceed 10 mg, regardless of calculated weight-based dose 1
- Dosing frequency should be every 6-8 hours (3-4 times daily maximum) 2, 3
Critical Duration Limitation
Treatment must be restricted to a maximum of 5 days to minimize the risk of extrapyramidal disorders and tardive dyskinesia 2. This is a firm regulatory recommendation from the European Medicines Agency that applies to all age groups, but is particularly important in pediatric patients who have higher susceptibility to neurological adverse effects.
Route of Administration
- IV or IM routes are preferred in acute settings for reliable absorption and rapid onset 1, 3
- Oral administration at 5-20 mg per dose can be used if the patient can tolerate oral intake, but should still follow weight-based dosing principles for pediatrics 2, 3
Essential Safety Precautions
High-Risk Adverse Effects in Pediatric Patients
- Extrapyramidal reactions (EPRs) occur more frequently in children and young adults compared to older adults 4, 5
- Acute dystonic reactions developed in approximately 38-45% of pediatric patients in studies using higher doses (1-2 mg/kg) 4, 5
- Akathisia (restlessness) occurred in 33% of children receiving doses ≥2 mg/kg 4
Contraindications
Avoid metoclopramide entirely in patients with: 1, 3
- Seizure disorders
- Pheochromocytoma
- GI bleeding or obstruction
- Severe renal or hepatic impairment (requires dose adjustment if used)
Monitoring Requirements
- Watch for dystonic reactions (involuntary movements, muscle spasms, particularly of face, neck, and extremities) which can occur even with low doses 6, 5
- Monitor for QT prolongation with repeated dosing 1
- Be prepared to administer diphenhydramine 25-50 mg IV/IM immediately if extrapyramidal symptoms develop 4, 5
Critical Pitfall to Avoid
Do not use consecutive day dosing if possible - children who received metoclopramide on consecutive days had significantly higher rates of extrapyramidal reactions 4. If multi-day treatment is absolutely necessary, consider prophylactic diphenhydramine with each dose 4, 5.
Alternative Consideration
Given the significant neurological risks in pediatric patients, ondansetron may be a safer first-line antiemetic for this age group, with typical dosing of 0.15 mg/kg IV (maximum 8 mg) 7. Reserve metoclopramide for cases where ondansetron has failed or when prokinetic effects are specifically needed (e.g., gastroparesis, severe gastroesophageal reflux) 8.