metoclopramide

Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.

Metoclopramide is used short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of symptoms.

Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.

Metoclopramide may also be used for purposes not listed in this medication guide.

Important information

NEVER TAKE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS.

High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take metoclopramide, the more likely you are to develop a serious movement disorder. The risk of this side effect is higher in women, diabetics, and older adults.

You should not take this medication if you are allergic to metoclopramide, or if you have bleeding or blockage in your stomach or intestines, epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma).

Before you take metoclopramide, tell your doctor if you have kidney or liver disease, congestive heart failure, high blood pressure, diabetes, Parkinson"s disease, or a history of depression.

Do not drink alcohol. It can increase some of the side effects of metoclopramide.

There are many other medicines that can interact with metoclopramide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Stop using metoclopramide and call your doctor at once if you have tremors or uncontrolled muscle movements, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing, depressed mood, thoughts of suicide or hurting yourself, hallucinations, anxiety, agitation, seizure, or jaundice (yellowing of your skin or eyes).

Before taking this medicine

You should not take this medication if you are allergic to metoclopramide, or if you have:

• bleeding or blockage in your stomach or intestines;

• a perforation (hole) in your stomach or intestines;

• epilepsy or other seizure disorder; or

• an adrenal gland tumor (pheochromocytoma).

To make sure you can safely take metoclopramide, tell your doctor if you have any of these other conditions:

• kidney disease;
• liver disease (especially cirrhosis);

• congestive heart failure, a heart rhythm disorder;

• high blood pressure;

• breast cancer;

• Parkinson"s disease;

• diabetes (your insulin dose may need adjusting); or

• depression or mental illness.

FDA pregnancy category B. Metoclopramide is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Metoclopramide can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

See also: Pregnancy and breastfeeding warnings (in more detail)

The metoclopramide orally disintegrating tablet (ODT) may contain phenylalanine. Talk to your doctor before using this form of metoclopramide if you have phenylketonuria (PKU).

Metoclopramide should not be given to a child.

How should I take metoclopramide?

Take metoclopramide exactly as prescribed by your doctor. Metoclopramide is usually taken for only 4 to 12 weeks. Follow the directions on your prescription label.

NEVER TAKE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS.

High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take metoclopramide, the more likely you are to develop a serious movement disorder. The risk of this side effect is higher in women, diabetics, and older adults.

Take metoclopramide 30 minutes before eating. Metoclopramide is usually taken before meals and at bedtime. Your doctor may want you to take the medication as needed only with meals that usually cause heartburn. Follow your doctor"s instructions.

Measure the liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

To take metoclopramide orally disintegrating tablet (ODT):

• Keep the tablet in its bottle or blister pack until you are ready to take the medicine. Make sure your hands are dry before handling a tablet. If the tablet breaks or melts in your hand, throw it away and use a new tablet.

• Place the tablet on your tongue. It will begin to melt right away. Do not swallow the tablet whole. Allow it to melt in your mouth without chewing.

• Swallow several times as the tablet melt. You do not need to drink liquid to help the tablet melt.

Do not take two different forms of metoclopramide (such as tablets and oral syrup) at the same time. Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. After you stop taking metoclopramide, you may have unpleasant withdrawal symptoms such as headache, dizziness, or nervousness. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, confusion, tremors or uncontrolled muscle movements in your face or neck, or seizure (convulsions).

What should I avoid?

Avoid drinking alcohol. It can increase some of the side effects of metoclopramide. This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Metoclopramide side effects

Get emergency medical help if you have any of these signs of an allergic reaction to metoclopramide: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking metoclopramide and call your doctor at once if you have any of these SIGNS OF A SERIOUS MOVEMENT DISORDER, which may occur within the first 2 days of treatment:

• tremors or shaking in your arms or legs;

• uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or

• any new or unusual muscle movements you cannot control.

Stop taking metoclopramide and call your doctor at once if you have any of these other serious side effects:

• slow or jerky muscle movements, problems with balance or walking;

• mask-like appearance in your face;

• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;

• depressed mood, thoughts of suicide or hurting yourself;

• hallucinations, anxiety, agitation, jittery feeling, trouble staying still;

• swelling, feeling short of breath, rapid weight gain;

• jaundice (yellowing of your skin or eyes); or

• seizure (convulsions).

Less serious metoclopramide side effects may include:

• feeling restless, drowsy, tired, or dizzy;

• headache, sleep problems (insomnia);

• nausea, vomiting, diarrhea;

• breast tenderness or swelling;

• changes in your menstrual periods; or

• urinating more than usual.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Metoclopramide dosing information

Usual Adult Metoclopramide Dose for Nausea/Vomiting:

Postoperative nausea and vomiting:
Parenteral: 10 to 20 mg IM at or near the end of surgery

Usual Adult Metoclopramide Dose for Gastroesophageal Reflux Disease:

Oral: 10 to 15 mg up to 4 times a day 30 minutes before meals and at bedtime, depending upon symptoms being treated and clinical response. Therapy should not exceed 12 weeks.

Usual Adult Metoclopramide Dose for Small Intestine Intubation:

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single (undiluted) dose may be administered IV slowly over 1 to 2 minutes:
Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2 minutes.

Usual Adult Metoclopramide Dose for Radiographic Exam:

Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2 minutes to facilitate gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

Usual Adult Metoclopramide Dose for Gastroparesis:

During the earliest manifestations of diabetic gastric stasis, oral administration may be initiated. If severe symptoms are present, therapy should begin with IM or IV administration for up to 10 days until symptoms subside at which time the patient can be switched to oral therapy. Since diabetic gastric stasis is often recurrent, therapy should be reinstituted at the earliest manifestation.

Parenteral: 10 mg 4 times daily, IV (slowly over a 1 to 2 minute period) or IM for up to 10 days.

Oral: 10 mg 4 times daily, 30 minutes before meals and at bedtime, for 2 to 8 weeks depending on clinical response.

Usual Adult Metoclopramide Dose for Nausea/Vomiting -- Chemotherapy Induced:

IV infusion: 1 to 2 mg/kg/dose (depending on the emetogenic potential of the agent) IV (infused over a period of not less than 15 minutes) 30 minutes before administration of chemotherapy. The dose may be repeated twice at 2 hour intervals following the initial dose. If vomiting is still not suppressed, the same dose may be repeated 3 more times at 3 hour intervals.

For doses higher than 10 mg, the injection should be diluted in 50 mL of a parenteral solution. Normal saline is the preferred diluent.

If acute dystonic reactions occur, 50 mg of diphenhydramine hydrochloride may be injected IM.

Usual Adult Metoclopramide Dose for Migraine:

Use for treatment of migraine headaches is not an FDA approved indication; however, metoclopramide has shown efficacy in studies at a dose of 10 to 20 mg IV once (used in combination with analgesics or ergot derivatives).

Usual Pediatric Metoclopramide Dose for Gastroesophageal Reflux Disease:

Metoclopramide is not approved by the FDA for gastroesophageal reflux disease in pediatric patients; however, the following doses have been studied:

Oral, IM, IV:
Infants and Children: 0.4 to 0.8 mg/kg/day in 4 divided doses

Usual Pediatric Metoclopramide Dose for Small Intestine Intubation:

Metoclopramide IV is approved by the FDA for pediatric use to facilitate small bowel intubation by causing gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single (undiluted) dose may be administered IV slowly over 1 to 2 minutes:

Less than 6 years: 0.1 mg/kg IV as a single dose

6 to 14 years: 2.5 to 5 mg IV as a single dose

Children greater than 14 years: 10 mg as a single dose

Usual Pediatric Metoclopramide Dose for Nausea/Vomiting -- Chemotherapy Induced:

Metoclopramide is not approved by the FDA for chemotherapy induced nausea and vomiting in pediatric patients; however, the following doses have been studied:

IV:
1 to 2 mg/kg/dose IV every 30 minutes before chemotherapy and every 2 to 4 hours

Usual Pediatric Metoclopramide Dose for Nausea/Vomiting -- Postoperative:

Metoclopramide is not approved by the FDA for postoperative nausea and vomiting in pediatric patients; however, the following doses have been studied:
IV:
Children less than or equal to 14 years: 0.1 to 0.2 mg/kg/dose (maximum dose: 10 mg/dose); repeat every 6 to 8 hours as needed
Children greater than 14 years and Adults: 10 mg; repeat every 6 to 8 hours as needed

What other drugs will affect metoclopramide?

Before using metoclopramide, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by metoclopramide.

Tell your doctor about all other medications you use, especially:

• acetaminophen (Tylenol);

• cyclosporine (Gengraf, Neoral, Sandimmune);

• digoxin (digitalis, Lanoxin);

• glycopyrrolate (Robinul);

• insulin;

• levodopa (Larodopa, Atamet, Parcopa, Sinemet);

• mepenzolate (Cantil);

• tetracycline (Ala-Tet, Brodspec, Panmycin, Sumycin, Tetracap);

• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);

• bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

• blood pressure medications;

• bronchodilators such as ipratroprium (Atrovent) or tiotropium (Spiriva);

• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin), or propantheline (Pro-Banthine);

• an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (Clozaril, FazaClo), haloperidol (Haldol), olanzapine (Zyprexa, Symbyax), prochlorperazine (Compazine), risperidone (Risperdal), thiothixene (Navane), and others.

This list is not complete and there are many other drugs that can interact with metoclopramide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.