Uses
Diabetic Gastric Stasis
Symptomatic treatment of acute and recurrent diabetic gastric stasis (gastroparesis). Successful therapy often requires long-term, intermittent use, since diabetic gastric stasis is a chronic, recurrent disease.
Postsurgical Gastric Stasis
Has been used for the symptomatic treatment of acute and chronic postsurgical gastric stasis† following vagotomy and gastric resection or vagotomy and pyloroplasty.
Prevention of Postoperative Nausea and Vomiting
Prevention of postoperative nausea and vomiting when nasogastric suction is considered undesirable.
Prevention of Cancer Chemotherapy-induced Emesis
Used parenterally in high doses for the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy including cisplatin alone or in combination with other antineoplastic agents.
Prevention of nausea and vomiting associated with other antineoplastic agents (e.g., cyclophosphamide, dacarbazine, doxorubicin, methotrexate) and with cancer chemotherapy regimens that do not include cisplatin.
Occasionally used orally† in high doses for the prevention of chemotherapy-induced nausea and vomiting. Additional study is needed to determine efficacy of oral use.
Intubation of the Small Intestine
Used parenterally to facilitate small intestine intubation when the tube (e.g., endoscope, biopsy tube) does not pass through the pylorus during 10 minutes of conventional maneuvers.
Radiographic Examination of the Upper GI Tract
Used parenterally to stimulate gastric emptying and intestinal transit of barium when delayed emptying interferes with radiographic examination of the stomach and/or small intestine.
Gastroesophageal Reflux
Short-term (≤12 weeks) relief of symptomatic, documented gastroesophageal reflux in adults who are unresponsive to conventional therapy (e.g., changes in lifestyle, habits, diet, weight reduction) alone. Regular use for this purpose has declined; proton-pump inhibitors provide greater control of acid reflux.
Dosage and Administration
Administration
Administer orally, by direct IV injection or IV infusion, or IM.
Oral Administration
When metoclopramide oral concentrate solution is used, dilute with water, juice, or carbonated beverages or mix with semisolid foods (e.g., applesauce, pudding) just prior to administration.
IV Administration
For solution and drug compatibility information, see Compatibility under Stability.
Dilution
For direct IV injection, use without further dilution.
For IV infusion, manufacturer recommends dilution in 50 mL of 5% dextrose, 0.9% sodium chloride, 5% dextrose and 0.45% sodium chloride, Ringer’s, or lactated Ringer’s injection.
Manufacturer states that 0.9% sodium chloride injection is preferred because metoclopramide hydrochloride is most stable in this solution.
Rate of Administration
Direct IV injection: Administer each 10 mg slowly over 1–2 minutes. Rapid IV injection may cause transient but intense feelings of anxiety and restlessness, followed by drowsiness.
IV infusion: Administer slowly over ≥15 minutes.
IM Administration
Inject without further dilution.
Dosage
Available as metoclopramide hydrochloride; dosage expressed in terms of metoclopramide.
Pediatric Patients
Intubation of the Small Intestine
IV
Children <6 years of age: Usually, one 0.1-mg/kg dose given by direct IV injection.
Children 6–14 years of age: Usually, one 2.5- to 5-mg dose given by direct IV injection.
Children >14 years of age: Usually, one 10-mg dose given by direct IV injection.
Radiographic Examination of the Upper GI Tract
IV
Children <6 years of age: Usually, one 0.1 mg/kg dose given by direct IV injection.
Children 6–14 years of age: Usually, one 2.5- to 5-mg dose given by direct IV injection.
Adults
Diabetic Gastric Stasis
Oral
10 mg 4 times daily, given 30 minutes before meals and at bedtime. Continue for 2–8 weeks, depending on response and likelihood of continued well-being if drug is discontinued. Reinstitute at earliest symptom recurrence.
IV
If symptoms are severe or oral use is not feasible, 10 mg 4 times daily, given by direct IV injection 30 minutes before meals and at bedtime. Continue until symptoms subside enough to allow oral administration.
IM
If symptoms are severe or oral use is not feasible, 10 mg 4 times daily, given 30 minutes before meals and at bedtime. Continue until symptoms subside enough to allow oral administration.
Prevention of Postoperative Nausea and Vomiting
IM
Usually, 10 mg administered near the end of the surgical procedure; 20 mg also may be used. Repeat every 4–6 hours as necessary.
Prevention of Cancer Chemotherapy-induced Emesis
Oral
2 mg/kg has been given 1 hour before administration of highly emetogenic chemotherapy and repeated 3 times at 2-hour intervals (i.e., at 1, 3, and 5 hours after initiation of chemotherapy); may give 2 additional doses at 3-hour intervals (i.e., at 8 and 11 hours after initiation of chemotherapy) for a total daily dose of 12 mg/kg.†
Total daily dose of 6 mg/kg has been used in patients who developed intolerable adverse effects with the higher daily dose.†
IV
Initially, 2 mg/kg given by IV infusion 30 minutes before administration of highly emetogenic chemotherapy; repeat twice at 2-hour intervals. If vomiting is suppressed, may then decrease dosage to 1 mg/kg at 3-hour intervals for 3 additional doses. If vomiting is not suppressed after initial 3 doses, may continue 2-mg/kg doses at 3-hour intervals for 3 additional doses.
For less emetogenic drugs or regimens, initial 1-mg/kg doses may be sufficient.
Doses up to 2.75 mg/kg† have been used in patients receiving cisplatin alone or in combination with other antineoplastic agents when emesis was not adequately controlled with 2 mg/kg and substantial metoclopramide toxicity was not present.
Intubation of the Small Intestine
IV
Usually, one 10-mg dose given by direct IV injection.
Radiographic Examination of the Upper GI Tract
IV
Usually, one 10-mg dose given by direct IV injection.
Gastroesophageal Reflux
Oral
Usually, 10–15 mg up to 4 times daily (30 minutes before each meal and at bedtime) for 4–12 weeks, depending on symptoms and response. Patients sensitive to therapeutic and/or adverse effects of metoclopramide may require initial dose of 5 mg.
For intermittent symptoms or symptoms at specific times of the day, one 20-mg dose before the provoking situation may be preferred to daily administration of multiple doses.
In patients with esophageal erosion and ulceration, 15 mg 4 times daily for 12 weeks has provided healing; monitor endoscopically because of the poor correlation between symptoms and healing.
Prescribing Limits
Adults
Gastroesophageal Reflux
Oral
Safety and efficacy beyond 12 weeks not established; use beyond 12 weeks is not recommended.
Special Populations
Dosage in Hepatic Impairment
Dosage modification does not appear to be necessary.
Dosage in Renal Impairment
Modify dosage according to degree of renal impairment.
In patients with Clcr <40 mL/minute, manufacturers recommend an initial dosage of approximately 50% of the usual dosage. Subsequently, increase or decrease dosage according to response and tolerance.
Geriatric Patients
Administer lowest effective dosage. In geriatric patients with gastroesophageal reflux, initial 5-mg dose may be required due to possible sensitivity to therapeutic and/or adverse effects of metoclopramide.
If parkinsonian symptoms occur, generally discontinue drug before initiating antiparkinsonian agents.
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