From the Guidelines
Metoclopramide (Reglan) is used to treat gastroparesis, a condition where the stomach takes too long to empty its contents.
Uses of Metoclopramide
- It is a prokinetic agent that helps improve gastrointestinal motility.
- The FDA has approved metoclopramide for the treatment of gastroparesis, but its use is recommended only for severe cases that are unresponsive to other therapies and not beyond 12 weeks due to the risk of serious adverse effects such as extrapyramidal signs, acute dystonic reactions, drug-induced parkinsonism, akathisia, and tardive dyskinesia 1.
Important Considerations
- The level of evidence regarding the benefits of metoclopramide for the management of gastroparesis is weak.
- Other treatment options for gastroparesis include domperidone (available outside the U.S.) and erythromycin, which is only effective for short-term use due to tachyphylaxis.
- Gastric electrical stimulation using a surgically implantable device has received FDA approval, but its efficacy is variable and use is limited to individuals with severe symptoms that are refractory to other treatments 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 (Reglan) is used for:
- Relieving symptoms of slow stomach emptying in people with diabetes
- Preventing nausea and vomiting caused by cancer chemotherapy
- Preventing nausea and vomiting after surgery
- Facilitating the insertion of a tube into the small intestine
- Aiding in the emptying of stomach contents or movement of barium through the intestine for X-ray examinations 2
From the Research
Uses of Metoclopramide (Reglan)
- Metoclopramide is used as an antiemetic and gastroprokinetic to treat various gastrointestinal symptoms 3
- It is used to treat diabetic gastroparesis, a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction 4
- Metoclopramide is also used to facilitate intubation of the small intestine and the passage of barium into the intestine for radiographic procedures 5
- It has been used in the treatment of vomiting of various etiologies, including vomiting secondary to anesthesia and chemotherapy 5
Mechanism of Action
- Metoclopramide acts as a dopamine receptor antagonist, with 5HT3 receptor antagonist and 5HT4 receptor agonist activity 3
- It enhances the rate of gastric emptying by augmenting esophageal peristalsis, gastric antral contractions, and small intestine transit time 5
- Metoclopramide increases resting pressures of the lower esophageal and pyloric sphincters, but does not stimulate gastric acid secretions 5
Side Effects and Contraindications
- Common side effects of metoclopramide include drowsiness, GI disturbances, extrapyramidal reactions, and increased lactation 5
- Metoclopramide carries a black box warning for use >12 weeks due to the risk of tardive dyskinesia (TD), a movement disorder that may be irreversible 4
- It should not be given in combination with MAO inhibitors, tricyclic antidepressants, sympathomimetic amines, or to patients with pheochromocytoma, GI hemorrhage, obstruction, or perforation 5