What is the indication for Metoclopramide (antiemetic medication)?

From the Guidelines

Metoclopramide is primarily used to treat gastroparesis, a condition characterized by delayed stomach emptying, and is the only FDA-approved medication for this condition. It works by increasing muscle contractions in the upper digestive tract, which speeds up the rate at which the stomach empties into the intestines and helps move food through the digestive system more efficiently 1. Common uses include managing nausea and vomiting associated with chemotherapy, radiation therapy, surgery, and migraine headaches. It's also prescribed for gastroesophageal reflux disease (GERD). Typical adult dosing ranges from 5-10 mg taken up to four times daily, with treatment duration often limited to 12 weeks or less due to risk of side effects, as recommended by the FDA 1.

Key Points

• Metoclopramide is used to treat gastroparesis, nausea, vomiting, and certain digestive disorders
• It works by increasing muscle contractions in the upper digestive tract
• Typical adult dosing ranges from 5-10 mg taken up to four times daily
• Treatment duration is often limited to 12 weeks or less due to risk of side effects
• Metoclopramide can cause side effects including drowsiness, restlessness, and rarely, serious movement disorders with long-term use, as noted in the study by 1

Important Considerations

• Metoclopramide should be used at the lowest effective dose for the shortest duration necessary
• Patients should be aware of the potential side effects and monitor their condition closely while taking the medication
• The medication is also used off-label for other conditions, such as managing nausea and vomiting associated with chemotherapy and radiation therapy, as discussed in the study by 1
• Other treatment options for gastroparesis include domperidone, erythromycin, and gastric electrical stimulation, as outlined in the study by 1

From the FDA Drug Label

Metoclopramide is a prescription medicine used to: • relieve symptoms of slow stomach emptying in people with diabetes • prevent nausea and vomiting that can happen with cancer chemotherapy • prevent nausea and vomiting that may happen after surgery, if your doctor decides that you should not be treated with a stomach tube and suction • help make it easier to insert a tube into the small intestine in both adults and children, if the tube does not pass into the stomach normally. • to help empty stomach contents or to help barium move through your intestine, when you get an X-ray examination of the stomach or small intestine.

Metoclopramide is used for several purposes, including:

• Relieving symptoms of slow stomach emptying in people with diabetes
• Preventing nausea and vomiting associated with cancer chemotherapy or surgery
• Facilitating small bowel intubation in adults and children
• Stimulating gastric emptying and intestinal transit of barium for radiological examinations 2, 2

From the Research

Metoclopramide Uses

• Metoclopramide is used to treat and prevent various types of vomiting, as well as to manage gastroparesis, dyspepsia, and other functional gastrointestinal disorders 3, 4, 5.
• It is also used to prevent nausea and vomiting associated with cisplatin therapy 3 and to relieve emesis induced by cytotoxic agents 4.
• Additionally, metoclopramide is used to manage gastro-oesophageal reflux and gastric stasis 4, and to investigate the role of dopamine in physiological and pathological processes 4.
• In some cases, metoclopramide is used to prevent post-operative vomiting and radiation sickness, and to ameliorate drug-induced vomiting 5.
• It may also provide symptomatic relief in dyspepsia, reflux oesophagitis, and hiccups, although further controlled trials are needed to confirm its efficacy in these areas 5.

Comparison with Other Medications

• A study compared the efficacy of metoclopramide and ondansetron in preventing nausea and vomiting in patients with renal colic, and found that ondansetron was more effective in preventing vomiting 6.
• Metoclopramide is often used in combination with other medications, such as antiemetic agents and antidiabetic agents, to manage gastroparesis and other conditions 7.