What is the use of Metoclopramide (Reglan)?

From the Guidelines

Metoclopramide should be used at a dose of 5-20 mg tid-qid for the treatment of gastroparesis, with a treatment duration limited to 12 weeks or less to minimize the risk of side effects, as recommended by the most recent and highest quality study 1.

Key Points

• Metoclopramide is a prokinetic medication that works by blocking dopamine receptors in the chemoreceptor trigger zone and stimulating upper GI motility, effectively increasing gastric emptying and intestinal transit.
• The typical adult dose is 10 mg orally or intravenously, taken up to four times daily, with treatment duration generally limited to 12 weeks or less to minimize risk of side effects.
• For gastroparesis, it's often prescribed as 10 mg 30 minutes before meals and at bedtime, as stated in the study 1.
• Common side effects include drowsiness, restlessness, and fatigue, while more serious concerns include extrapyramidal symptoms (muscle spasms, tremors) and tardive dyskinesia with long-term use.
• Metoclopramide should be used cautiously in elderly patients and is contraindicated in patients with seizure disorders, pheochromocytoma, and those taking medications that might cause extrapyramidal reactions, as noted in the study 1.

Important Considerations

• The FDA has placed a black box warning limiting duration of therapy to 12 weeks or less due to the risk of serious adverse effects.
• The medication should be tapered rather than abruptly discontinued after extended use to prevent withdrawal symptoms.
• Metoclopramide is the only FDA-approved medication for the treatment of gastroparesis, and its use should be reserved for severe cases that are unresponsive to other therapies, as recommended by the study 1.

From the FDA Drug Label

Metoclopramide can cause serious side effects, including: Abnormal muscle movements called tardive dyskinesia (TD). Your chances for getting TD go up: the longer you take metoclopramide and the more metoclopramide you take. You should not take metoclopramide for more than 12 weeks The main concern with metoclopramide is the risk of developing tardive dyskinesia (TD), which increases with longer treatment duration and higher doses.

• The recommended duration of metoclopramide treatment is not more than 12 weeks 2, 2. Key points to consider when prescribing metoclopramide include:
• Monitoring for signs of TD, such as abnormal muscle movements
• Limiting treatment duration to minimize the risk of TD
• Assessing the risks and benefits of continued treatment with metoclopramide 2.

From the Research

Metoclopramide Overview

• Metoclopramide is a dopamine receptor antagonist with 5HT3 receptor antagonist and 5HT4 receptor agonist activity, used as an antiemetic and gastroprokinetic for almost 50 years 3.
• It is primarily used to treat gastroparesis, a disorder characterized by delayed gastric emptying due to chronic abnormal gastric motility 4.

Risks and Side Effects

• The risk of tardive dyskinesia from metoclopramide is low, in the range of 0.1% per 1000 patient years 3.
• High-risk groups for tardive dyskinesia include elderly females, diabetics, patients with liver or kidney failure, and patients with concomitant antipsychotic drug therapy 3.
• Metoclopramide can also cause other side effects, such as drowsiness, restlessness, hyperprolactinemia, and extrapyramidal side effects like parkinsonism, dystonia, and akithisia 5, 6.
• There is a reported case of acute chorea associated with metoclopramide use, which is a rare side effect 7.

Clinical Use

• Metoclopramide is the only drug approved by the Food and Drug Administration for diabetic gastroparesis 5.
• It is used to improve gastric emptying and reduce nausea and vomiting in patients with gastroparesis 4, 5.
• However, its use is limited by the risk of tardive dyskinesia, and physicians and patients are looking forward to FDA approval of new agents with better efficacy and safety profiles 5.