What is the recommended dosage of Maxeran (Metoclopramide) when administered intramuscularly (IM)?

Maxeran (Metoclopramide) Intramuscular Dosing

The standard intramuscular dose of Maxeran (metoclopramide) is 10 mg administered as a single injection, which can be repeated based on the clinical indication, with a maximum daily dose of 30 mg and treatment duration limited to 5 days to minimize the risk of serious neurological complications. 1, 2

Standard IM Dosing by Indication

Postoperative Nausea and Vomiting

• 10 mg IM administered near the end of surgery 1
• Doses of 20 mg may be used in select cases 1

Diabetic Gastroparesis

• 10 mg IM when severe symptoms are present and oral administration is not feasible 1
• May require up to 10 days of parenteral therapy before transitioning to oral administration 1

General Nausea and Vomiting

• 10 mg IM three to four times daily (maximum 30 mg/day) 2
• Treatment should be limited to short-term use (up to 5 days) 2

Critical Safety Considerations

Maximum Dosing Limits

• European regulatory agencies mandate a maximum daily dose of 30 mg and maximum treatment duration of 5 days to minimize serious neurological complications 2
• These restrictions apply to all indications and routes of administration 2

Extrapyramidal Symptoms (EPS)

• EPS occur in approximately 9% of pediatric patients and are more common in younger adults 3, 4
• If acute dystonic reactions occur, administer 50 mg diphenhydramine IM immediately 1
• Risk increases with repeated doses and prolonged use 4
• Symptoms typically resolve after discontinuation but rare cases of long-lasting effects (up to 13 months) have been reported even with low-dose, short-term use 5

Other Adverse Effects

• Common: sedation (6%), diarrhea (6%), drowsiness, dizziness 3, 6
• Rare but serious: neuroleptic malignant syndrome, tardive dyskinesia, QT prolongation with torsades de pointes 7, 3

Contraindications and Precautions

Avoid metoclopramide in patients with: 7, 2

• Pheochromocytoma
• Seizure disorders
• GI bleeding or obstruction
• Severe renal impairment (creatinine clearance <40 mL/min requires dose reduction to approximately half) 1
• Severe hepatic impairment

Special Populations

Renal Impairment

• When creatinine clearance is below 40 mL/min, initiate therapy at approximately one-half the recommended dosage 1
• Dosage may be adjusted based on clinical efficacy and safety 1

Elderly Patients

• Patients over 59 years may require dose reduction due to higher risk of adverse effects 2

Pregnancy

• Metoclopramide is recommended as second-line therapy for hyperemesis gravidarum 8
• No increased risk of congenital defects reported, but extrapyramidal effects may occur 8
• Should be withdrawn if extrapyramidal symptoms develop 8

Clinical Pearls

• IM route is preferred when oral administration is not feasible due to severe symptoms or inability to tolerate oral medications 1
• The antiemetic effect is due to combined actions on the chemoreceptor trigger zone and intestinal motility 6
• Metoclopramide is generally not intended for long-term use - parenteral use should be limited to one or two days when possible 6
• Always inspect the solution for particulate matter and discoloration before administration 1