Reglan (Metoclopramide) Daily Dose and Frequency
For adults, metoclopramide should be dosed at 10 mg orally or intravenously, administered 20-30 minutes before meals and at bedtime (four times daily), with a maximum daily dose of 40 mg, and doses must be reduced by 50-75% in patients with renal impairment. 1
Standard Adult Dosing
Oral Administration
- 10 mg four times daily (total 40 mg/day) taken 20-30 minutes before meals and at bedtime 1, 2
- This regimen has demonstrated efficacy in treating gastroparesis and upper gastrointestinal symptoms 2
Intravenous Administration
- 10 mg IV administered 20-30 minutes before meals or with analgesics for migraine 1
- Can be repeated as needed within the maximum daily limit
Maximum Daily Dose
- 40 mg per day is the standard maximum for adults 2
- Higher doses increase risk of extrapyramidal symptoms and other adverse effects
Critical Dosing Adjustments for Renal Impairment
Patients with renal failure require substantial dose reductions because metoclopramide clearance is reduced to approximately 30% of normal, and the elimination half-life extends from 4-6 hours to approximately 14 hours. 3, 4
Renal Dosing Guidelines
- Creatinine clearance correlates directly with metoclopramide plasma clearance 4
- In renal failure, both renal and non-renal clearance are reduced 4
- Reduce maintenance doses by 50-75% in patients with significant renal impairment to avoid drug accumulation 4
- The prolonged half-life (13.9-14.8 hours vs. normal 4-6 hours) necessitates extended dosing intervals 3
Specific Renal Impairment Recommendations
- Consider dosing 10 mg twice daily or three times daily instead of four times daily in moderate renal impairment
- In severe renal failure, consider 10 mg once or twice daily 5, 4
- Monitor closely for extrapyramidal symptoms, as five of six reported cases of metoclopramide-induced parkinsonism occurred in patients with renal failure 5
Important Safety Considerations
Movement Disorders and Neurological Effects
- Extrapyramidal reactions are dose-dependent and more common with renal impairment 5
- Symptoms include restlessness, drowsiness, dystonic reactions, and parkinsonism 1, 5
- Even short-term, low-dose therapy (30-40 mg total over days) can cause severe, long-lasting adverse effects lasting up to 10-13 months 6
Contraindications
- Pheochromocytoma, seizure disorder, gastrointestinal bleeding, and gastrointestinal obstruction 1
Common Pitfalls to Avoid
- Failing to reduce doses in elderly patients, who often have unrecognized renal impairment with GFR decreasing approximately 8 mL/min per decade after age 40 7
- Continuing standard dosing in renal failure patients, which leads to drug accumulation and increased risk of parkinsonism 5, 4
- Underestimating the duration of adverse effects—neurological symptoms can persist for months even after discontinuation 6
Hemodialysis Considerations
- Hemodialysis removes relatively small amounts of metoclopramide compared to total body stores 4
- Compensatory dose increases after dialysis are unnecessary 4
- Hemodialysis is not effective for metoclopramide overdose 4
Duration of Treatment
- Metoclopramide should be reserved for short-term use (typically days to weeks, not months) 6
- Long-term use increases risk of tardive dyskinesia and other movement disorders
- Re-evaluate need for continued therapy regularly, especially in patients experiencing any neurological symptoms