What are the contraindications for Reglan (Metoclopramide)?

From the Guidelines

Metoclopramide (Reglan) is contraindicated in patients with pheochromocytoma, seizure disorder, GI bleeding, and GI obstruction.

Contraindications

• The contraindications for metoclopramide are based on its potential to exacerbate certain conditions, such as:
  • Pheochromocytoma: metoclopramide may cause a hypertensive crisis in patients with this condition 1
  • Seizure disorder: metoclopramide may lower the seizure threshold and worsen seizure control 1
  • GI bleeding: metoclopramide may increase the risk of bleeding due to its effects on gastric motility and acid secretion 1
  • GI obstruction: metoclopramide may worsen intestinal obstruction due to its prokinetic effects 1

Additional Considerations

• Metoclopramide should be used with caution in patients with a history of extrapyramidal disorders, such as Parkinson's disease, due to the risk of worsening symptoms 1
• The European Medicines Agency (EMA) has recommended restricting metoclopramide to short-term use (up to 5 days) to minimize the risk of neurological side effects, such as extrapyramidal disorders 1
• The maximum recommended dose of metoclopramide in adults has been restricted to 30 mg/day to minimize the risk of adverse effects 1

From the FDA Drug Label

Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction or perforation. Metoclopramide is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phentolamine. Metoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug. Metoclopramide should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

Do not receive metoclopramide if you: • have stomach or intestine problems that could get worse with metoclopramide, such as bleeding, blockage or a tear in your stomach or bowel wall • have an adrenal gland tumor called pheochromocytoma • are allergic to metoclopramide or anything in it. • take medicines that can cause uncontrolled movements, such as medicines for mental illness • have seizures

The contraindications for Reglan (Metoclopramide) are:

• Gastrointestinal hemorrhage
• Mechanical obstruction
• Perforation
• Pheochromocytoma
• Known sensitivity or intolerance to the drug
• Epileptics
• Patients receiving other drugs which are likely to cause extrapyramidal reactions
• Stomach or intestine problems that could get worse with metoclopramide
• Allergic to metoclopramide or anything in it
• Take medicines that can cause uncontrolled movements
• Seizures 2 2

From the Research

Contraindications for Reglan (Metoclopramide)

• The following are contraindications for Reglan (Metoclopramide) as stated in the studies:
  • Combination with MAO inhibitors, tricyclic antidepressants, sympathomimetic amines, or to patients with pheochromocytoma 3
  • GI hemorrhage, obstruction, or perforation 3
  • Long-term use (>12 weeks) due to the risk of tardive dyskinesia, a movement disorder that may be irreversible 4, 5, 6
• High-risk groups for tardive dyskinesia include:
  • Elderly females
  • Diabetics
  • Patients with liver or kidney failure
  • Patients with concomitant antipsychotic drug therapy 5, 6
• It is recommended to limit the use of parenteral metoclopramide to one or two days and oral preparations for four to 12 weeks of therapy 7