Metoclopramide is a dopamine antagonist and prokinetic agent widely utilized in clinical practice for the management of gastrointestinal motility disorders and nausea. It functions by accelerating gastric emptying and enhancing coordination of antrroduodenal motility, while also exerting antiemetic effects through central dopamine receptor blockade in the chemoreceptor trigger zone. This medication is available in multiple formulations, including oral tablets, oral solution, and injectable forms, allowing for flexible administration based on patient needs and clinical context. Its established efficacy and rapid onset of action make it a valuable therapeutic option in both acute and chronic settings.

Features

• Active ingredient: Metoclopramide hydrochloride
• Available formulations: Oral tablets (5 mg, 10 mg), oral solution (5 mg/5 mL), injectable solution (5 mg/mL)
• Mechanism of action: Dopamine D2 receptor antagonist; enhances acetylcholine release in the myenteric plexus
• Onset of action: Oral: 30–60 minutes; IV: 1–3 minutes; IM: 10–15 minutes
• Duration of effect: 1–2 hours for antiemetic effect; up to 12 hours for prokinetic effects with repeated dosing
• Half-life: Approximately 5–6 hours
• Metabolism: Hepatic, primarily via CYP2D6
• Excretion: Renal (approximately 85%)

Benefits

• Provides rapid relief from nausea and vomiting associated with chemotherapy, surgery, or migraine
• Improves symptoms of diabetic gastroparesis by enhancing gastric emptying and reducing postprandial fullness
• Effective in preventing postoperative nausea and vomiting when administered prophylactically
• May be used off-label to stimulate lactation in some clinical scenarios
• Available in multiple formulations to accommodate various patient needs and clinical situations
• Cost-effective compared to some newer antiemetic agents

Common use

Metoclopramide is indicated for the short-term (4–12 weeks) therapy of adults with symptomatic, documented gastroesophageal reflux disease who fail to respond to conventional therapy. It is also used for the relief of symptoms associated with acute and recurrent diabetic gastroparesis. Additionally, it is employed for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, prevention of postoperative nausea and vomiting, and to facilitate small bowel intubation and radiologic examinations where delayed gastric emptying interferes with these procedures.

Dosage and direction

Adults:

• For diabetic gastroparesis: 10 mg orally 30 minutes before each meal and at bedtime for 2–8 weeks
• For GERD: 10–15 mg orally up to four times daily 30 minutes before meals and at bedtime
• For chemotherapy-induced nausea/vomiting: 1–2 mg/kg IV 30 minutes before chemotherapy, then every 2 hours for two doses, then every 3 hours for three doses
• For postoperative nausea/vomiting: 10–20 mg IM at or near end of surgery

Elderly: Initiate with lower doses (5 mg) due to increased risk of adverse effects

Renal impairment: CrCl <40 mL/min: reduce dose by 50%

Administration: Take oral doses 30 minutes before meals and at bedtime. Do not crush or chew extended-release formulations. IV administration should be slow (over at least 1–2 minutes) to minimize risk of adverse effects.

Precautions

Use with caution in patients with depression, Parkinson’s disease, or hypertension. May cause drowsiness; patients should avoid driving or operating machinery until response is known. Long-term use (greater than 12 weeks) should be avoided due to risk of tardive dyskinesia. Use lowest effective dose for shortest duration. Monitor for extrapyramidal symptoms, particularly in children and young adults. May elevate prolactin levels; monitor for galactorrhea, amenorrhea, or gynecomastia with prolonged use. Use cautiously in patients with renal impairment and adjust dose accordingly.

Contraindications

Hypersensitivity to metoclopramide or any component of the formulation; gastrointestinal obstruction, perforation or hemorrhage; pheochromocytoma; epilepsy; history of tardive dyskinesia; concomitant use with drugs likely to cause extrapyramidal reactions. Should not be used in patients where stimulation of gastrointestinal motility might be dangerous.

Possible side effect

Common (≥1%): Restlessness, drowsiness, fatigue, diarrhea Less common: Extrapyramidal symptoms (dystonia, akathisia, parkinsonism), galactorrhea, menstrual disorders Rare but serious: Tardive dyskinesia (may be irreversible), neuroleptic malignant syndrome, depression, suicidal ideation Cardiovascular: Hypertension, hypotension, bradycardia Hematologic: Methemoglobinemia (especially in neonates) Endocrine: Hyperprolactinemia

Drug interaction

• Increased sedation with CNS depressants (alcohol, benzodiazepines, opioids)
• Enhanced extrapyramidal effects with antipsychotics
• Reduced absorption of drugs requiring gastric acidity (e.g., digoxin, levodopa)
• Increased bioavailability of cyclosporine
• CYP2D6 inhibitors may increase metoclopramide levels
• Anticholinergic drugs may antagonize prokinetic effects
• Serotonin syndrome risk with serotonergic drugs

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule. If multiple doses are missed, contact healthcare provider for guidance.

Overdose

Symptoms may include drowsiness, disorientation, extrapyramidal reactions, seizures, and cardiac conduction abnormalities. Management includes gastric lavage if recent ingestion, activated charcoal, and supportive care. Extrapyramidal symptoms may be treated with diphenhydramine or benztropine. There is no specific antidote. Dialysis is not effective due to high protein binding. Monitor ECG and vital signs. Contact poison control center for latest guidance.

Storage

Store at controlled room temperature (20–25°C or 68–77°F). Protect from light and moisture. Keep oral solution in original container. Do not freeze. Keep all medications out of reach of children and pets. Do not use if discolored or containing particulate matter. Discard unused portion of oral solution after 30 days of opening.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. The prescribing physician should be familiar with the complete prescribing information and monitor patients appropriately. Individual response to medication may vary. Not all possible uses, precautions, side effects, or interactions are listed here.

Reviews

“Metoclopramide has been invaluable in our gastroenterology practice for managing refractory gastroparesis symptoms. While we strictly limit duration of use due to TD risk, its prokinetic effects are superior to many alternatives for selected patients.” - Gastroenterologist, 15 years experience

“In our oncology unit, metoclopramide remains a cost-effective option for chemotherapy-induced nausea, though we typically reserve it for patients who cannot tolerate newer antiemetics. The extrapyramidal side effects require careful monitoring.” - Oncology Pharmacist

“While effective for acute nausea, I’ve seen several cases of tardive dyskinesia with prolonged use. This medication demands respect and careful patient selection with explicit discussion of risks.” - Neurologist