What is the recommended dose and frequency of metoclopramide (Intravenous (IV) or Intramuscular (IM)) for a 12-year-old patient?

Metoclopramide IV/IM Dosing for a 12-Year-Old

For a 12-year-old child, administer metoclopramide 10 mg IV slowly over 1-2 minutes or IM, which can be repeated every 6-8 hours as needed, with a maximum daily dose not exceeding 30-40 mg. 1

Dose Calculation and Administration

Standard Dosing

• Weight-based dosing: 0.1 mg/kg per dose is the recommended pediatric calculation 1
• Fixed dose for age 12: Since children ≥14 years receive the adult dose of 10 mg, and children 6-14 years receive 2.5-5 mg for certain indications, a 12-year-old typically receives 10 mg per dose for most therapeutic uses 1
• Route: Can be given either IV (slowly over 1-2 minutes) or IM 1

Frequency and Maximum Dosing

• Frequency: Every 6-8 hours as needed 2
• Maximum: Do not exceed 3-4 doses per day (30-40 mg total daily dose) to minimize risk of extrapyramidal reactions 3
• Duration: Parenteral metoclopramide should be limited to 1-2 days of use 1

Critical Safety Considerations

Extrapyramidal Reaction Risk

• Children and adolescents are at significantly higher risk for acute extrapyramidal reactions (EPRs) compared to older adults, with rates of 15-33% reported at higher doses 3
• Prophylactic diphenhydramine (25-50 mg IV or IM) should be strongly considered when administering metoclopramide to reduce EPR risk 3
• If acute dystonic reactions occur, immediately inject 50 mg diphenhydramine IM, and symptoms usually subside 1

Administration Technique

• IV route: Must be given slowly over 1-2 minutes to reduce side effects 1
• Never give as rapid IV push, as this increases risk of adverse reactions 1
• For doses requiring dilution (>10 mg), use 50 mL of normal saline and infuse over at least 15 minutes 1

Common Pitfalls to Avoid

Duration of Use

• Do not use for more than 1-2 days parenterally 1
• Prolonged use significantly increases risk of tardive dyskinesia and other movement disorders 4
• Even short-term, low-dose use has been associated with long-lasting adverse effects in young patients 4

Consecutive Day Dosing

• Children receiving metoclopramide on consecutive days have higher frequency of EPRs 3
• If multi-day treatment is necessary, consider alternative antiemetics or transition to oral route after initial parenteral dose 1

Monitoring Requirements

• Watch for restlessness, drowsiness, akathisia (motor restlessness), and involuntary movements 3, 5
• Monitor for dystonic reactions (muscle spasms, particularly of neck and face) which require immediate treatment 1
• Symptoms may include twitches, jerks, tremors of eyelids, tongue, neck, fingers, arms and legs 4

Indication-Specific Dosing

For Severe Nausea/Vomiting

• 10 mg IV/IM as single dose, may repeat every 6-8 hours 1
• Consider diphenhydramine prophylaxis 3

For Chemotherapy-Induced Emesis (if applicable)

• Higher doses (1-2 mg/kg) have been studied but carry substantially higher risk of EPRs (15-33%) 3
• Not recommended without specialist consultation and mandatory diphenhydramine co-administration 3

Renal Impairment Adjustment

• If creatinine clearance <40 mL/min, reduce dose by 50% and increase dosing interval 1
• Metoclopramide is primarily renally excreted 1