From the Guidelines
Metoclopramide should be dosed at 5-20 mg tid-qid for adults, with a maximum daily dose of 40-80 mg, as recommended by the most recent and highest quality study 1. The dose of metoclopramide may vary depending on the patient's condition and response to treatment.
- For adults, the typical dose range is 5-20 mg tid-qid, with a maximum daily dose of 40-80 mg.
- It is essential to start with the lowest effective dose and monitor for adverse effects, particularly in elderly patients or those with renal impairment.
- The treatment duration should be limited to 12 weeks for diabetic gastroparesis due to the risk of tardive dyskinesia with long-term use, as noted in the study 1.
- Metoclopramide works by blocking dopamine receptors in the chemoreceptor trigger zone and enhancing gastric emptying through increased acetylcholine release.
- Common side effects include drowsiness, restlessness, and extrapyramidal symptoms, and it should be used cautiously in patients with Parkinson's disease, depression, or those taking other medications that affect dopamine. The study 1 provides the most recent and highest quality evidence for the dosing of metoclopramide, and its recommendations should be followed to optimize treatment outcomes and minimize adverse effects.
From the FDA Drug Label
For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated. However, if severe symptoms are present, therapy should begin with metoclopramide injection (IM or IV) Doses of 10 mg may be administered slowly by the intravenous route over a 1 to 2 minute period.
The recommended dose of metoclopramide is 10 mg for the relief of symptoms associated with diabetic gastroparesis.
- The dose may be administered orally or intravenously, depending on the severity of symptoms.
- For intravenous administration, the dose should be given slowly over a 1 to 2 minute period 2.
From the Research
Metoclopramide Dose Information
- The dose of metoclopramide used in various studies varies, with some studies using 10 mg intravenously 3, 4 and others using 0.15 to 0.30 mg/kg 5 or 2 mg/kg 5.
- In the study comparing metoclopramide and ondansetron for the prevention of nausea and vomiting in patients with renal colic, 10 mg intravenous metoclopramide was used 3.
- In the study comparing the effects of metoclopramide and ondansetron on emergency service observation times in acute gastroenteritis-related nausea and vomiting cases, 10 mg metoclopramide slow infusion therapy was used 6.
- A review of antiemetic trials of metoclopramide found that high-dose metoclopramide (2 mg/kg) was effective in preventing cisplatin-induced emesis, while lower doses (0.15 to 0.30 mg/kg) were not effective 5.
Comparison with Ondansetron
- Several studies have compared the efficacy of metoclopramide and ondansetron in reducing nausea and vomiting, with some finding that ondansetron is more effective 3, 6, 7 and others finding no significant difference between the two drugs 4.
- A meta-analysis of six randomized controlled trials found that ondansetron was more effective than metoclopramide in preventing acute nausea and emesis associated with chemotherapy 7.