What are the indications for Metoclopramide (MET - Metoclopramide)?

From the Guidelines

Metoclopramide is primarily indicated for the treatment of symptomatic gastroesophageal reflux disease (GERD), diabetic gastroparesis, and prevention of chemotherapy-induced and postoperative nausea and vomiting, with a recommended dose of 5-20 mg orally or IV, as needed, for breakthrough therapy 1.

Indications and Dosage

• For GERD, the typical adult dose is 10-15 mg orally up to four times daily before meals and at bedtime.
• For diabetic gastroparesis, 10 mg orally four times daily 30 minutes before meals and at bedtime is recommended, typically for 2-8 weeks.
• For chemotherapy-induced nausea, 1-2 mg/kg IV 30 minutes before chemotherapy and repeated every 2 hours for 2 doses, then every 3 hours if needed.

Mechanism of Action and Side Effects

Metoclopramide works by blocking dopamine receptors in the chemoreceptor trigger zone and stimulating upper GI motility by enhancing acetylcholine release in the gut. It should be used cautiously in patients with Parkinson's disease, depression, or hypertension. Treatment duration should be limited when possible, as prolonged use (over 12 weeks) increases the risk of tardive dyskinesia, a potentially irreversible movement disorder. Other common side effects include restlessness, drowsiness, fatigue, and extrapyramidal symptoms, particularly in young adults.

Clinical Guidelines and Recommendations

According to the AGA clinical practice update on management of medically refractory gastroparesis, metoclopramide is the only FDA-approved medication for gastroparesis, and its use should be reserved for severe cases that are unresponsive to other therapies 1. The American College of Gastroenterology recommends metoclopramide as a first-line treatment for gastroparesis, with a dose of 10 mg orally four times daily 30 minutes before meals and at bedtime 1. The NCCN clinical practice guidelines in oncology recommend metoclopramide as a breakthrough therapy for chemotherapy-induced nausea and vomiting, with a dose of 5-20 mg orally or IV, as needed 1. The ASCO guideline update recommends metoclopramide as a breakthrough therapy for radiation-induced nausea and vomiting, with a dose of 5-20 mg orally or IV, as needed 1. The European Association for the Study of the Liver Clinical Practice Guidelines recommend metoclopramide as a second-line therapy for hyperemesis gravidarum, with a dose of 5-10 mg orally or IV, as needed 1. Overall, metoclopramide is a effective medication for the treatment of various gastrointestinal disorders, but its use should be carefully monitored due to the risk of side effects and interactions with other medications.

From the FDA Drug Label

INDICATIONS & USAGE Diabetic Gastroparesis (Diabetic Gastric Stasis) Metoclopramide Injection (metoclopramide hydrochloride, USP) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis The Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy Metoclopramide Injection is indicated for the prophylaxis of vomiting associated with emetogenic cancer chemotherapy The Prevention of Postoperative Nausea and Vomiting Metoclopramide Injection is indicated for the prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable Small Bowel Intubation Metoclopramide Injection may be used to facilitate small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers Radiological Examination Metoclopramide Injection may be used to stimulate gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and/or small intestine.

The indications for metoclopramide are:

• Diabetic Gastroparesis: relief of symptoms associated with acute and recurrent diabetic gastric stasis
• Prevention of Nausea and Vomiting: associated with emetogenic cancer chemotherapy
• Prevention of Postoperative Nausea and Vomiting: in circumstances where nasogastric suction is undesirable
• Small Bowel Intubation: to facilitate intubation in adults and pediatric patients
• Radiological Examination: to stimulate gastric emptying and intestinal transit of barium 2

From the Research

Metclopramide Indications

• Metoclopramide is used to prevent postoperative nausea and vomiting (PONV) 3
• It is also used to prevent chemotherapy-induced nausea and vomiting, with studies showing its efficacy in patients receiving non-cisplatin-containing regimens 4, 5, 6
• The drug has been shown to be effective in preventing nausea and vomiting in patients receiving combined chemotherapy, with a significant reduction in vomiting compared to placebo 6
• Metoclopramide can be administered orally or intravenously, with different dosing schedules and regimens used depending on the specific indication and patient population 3, 4, 5, 6
• While metoclopramide has been shown to be effective in preventing nausea and vomiting, it may not be as effective as other antiemetic agents, such as ondansetron, in certain patient populations 7

Dosage and Administration

• The optimal dosage and scheduling of metoclopramide for the prevention of PONV and chemotherapy-induced nausea and vomiting are not fully established, with different studies using varying dosing regimens 3, 4, 5, 6
• Metoclopramide has been administered at doses ranging from 0.25 mg/kg to 50 mg, with oral and intravenous routes of administration used 3, 4, 5, 6

Efficacy and Safety

• Metoclopramide has been shown to be effective in preventing nausea and vomiting in a significant proportion of patients, with response rates ranging from 47% to 96% 3, 4, 5, 6
• The drug is generally well-tolerated, with minor side effects such as sedation, dizziness, and drowsiness reported in some patients 3, 4, 5, 6