metoclopramide (Rx)

Brand and Other Names:Reglan, Metozolv ODT
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 5mg/mL

syrup

  • 5mg/5mL
  • 10mg/10mL

tablet

  • 5mg
  • 10mg

Dispersible tablets

  • 5mg
  • 10mg

Chemotherapy-Induced Nausea & Vomiting

2 mg/kg IV (infused over at least 15 minutes) 30 minutes before chemotherapy, then repeated 2 more times q2hr (after initial dose)  

Vomiting suppressed: Decrease to 1 mg/kg IV q3hr for 3 doses  

Vomiting not suppressed: Continue same dose q3hr for 3 doses

Diabetic Gastroparesis

10 mg IV/IM/PO q6hr 30 minutes before meals and at bedtime; use injectable dosing only if severe symptoms are present

Small Bowel Intubation/Radiologic Examination of Upper GI Tract

10 mg IV over 1-2 minutes

Gastroesophageal Reflux Disease

10-15 mg PO q6hr 30 minutes before meals and at bedtime; not to exceed 80 mg/day

Postoperative Nausea & Vomiting (Off-label)

10-20 mg IM administered near end of procedure; may be repeated postoperatively q4-6hr PRN

Dosing Modifications

Renal impairment: CrCl <40 mL/min, decrease dose by 50%; CrCl <10 mL/min, decrease dose by 75%

Dosage Forms & Strengths

injectable solution

  • 5mg/mL

syrup

  • 5mg/5mL
  • 10mg/10mL

tablets

  • 5mg
  • 10mg

Dispersible tablets

  • 5mg
  • 10mg

Small Bowel Intubation/Radiologic Examination of Upper GI Tract

<6 years old: 0.1 mg/kg IV over 1-2 minutes  

6-14 years old: 2.5-5 mg IV over 1-2 minutes

≥14 years old: 10 mg IV over 1-2 minutes

Gastroesophageal Reflux Disease (Off-label)

Neonate: 0.15 mg/kg IV q6hr  

Infant: 0.1 mg/kg IV/IM/PO q6-8hr 30 minutes before meals and at bedtime  

Not to exceed 0.3-0.75 mg/kg/day  

Diabetic Gastroparesis (Off-label)

<6 years old: 0.1 mg/kg PO q8hr; not to exceed 0.1 mg/kg  

≥6 years old: 0.5 mg/kg/day PO divided q8hr

Postoperative Nausea & Vomiting (Off-label)

0.1-2 mg/kg IV q6-8hr PRN  

Chemotherapy-Induced Nausea & Vomiting (Off-label)

1-2 mg/kg IV (infused over at least 15 minutes) 30 minutes before chemotherapy; repeat q2-4hr; pretreatment with diphenhydramine decreases risk of extrapyramidal adverse effects  

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Interactions

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            Contraindicated (1)

            • lurasidone

              metoclopramide increases toxicity of lurasidone by antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Contraindicated. Concomitant use of metoclopramide and antipsychotics is contraindicated by the manufacturer of metoclopramide; increased risk of extrapyramidal effects. .

            Serious - Use Alternative (22)

            • cabergoline

              metoclopramide decreases levels of cabergoline by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated.

              metoclopramide decreases levels of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • citalopram

              metoclopramide and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • desvenlafaxine

              metoclopramide and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • dopamine

              metoclopramide decreases levels of dopamine by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated.

              metoclopramide decreases levels of dopamine by pharmacodynamic antagonism. Contraindicated.

            • duloxetine

              metoclopramide and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • escitalopram

              metoclopramide and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • fluoxetine

              metoclopramide and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • fluvoxamine

              fluvoxamine and metoclopramide both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects: Increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • levodopa inhaled

              metoclopramide decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of dopamine D2 receptor antagonists with levodopa inhaled.

            • levomilnacipran

              metoclopramide and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • lisuride

              metoclopramide decreases levels of lisuride by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated.

              metoclopramide decreases levels of lisuride by pharmacodynamic antagonism. Contraindicated.

            • methyldopa

              metoclopramide decreases levels of methyldopa by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated.

              metoclopramide decreases levels of methyldopa by pharmacodynamic antagonism. Contraindicated.

            • milnacipran

              metoclopramide and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • paroxetine

              metoclopramide and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • pramipexole

              metoclopramide decreases levels of pramipexole by pharmacodynamic antagonism. Contraindicated.

            • red yeast rice

              metoclopramide will increase the level or effect of red yeast rice by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. May increase creatine kinase levels and increase risk of myopathy or rhabdomyolysis; red yeast rice contains monocolin K (reportedly identical to lovastatin)

            • rivastigmine

              rivastigmine, metoclopramide. Either increases toxicity of the other by antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Avoid or Use Alternate Drug.

              metoclopramide, rivastigmine. Either increases toxicity of the other by antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Avoid or Use Alternate Drug.

            • ropinirole

              metoclopramide decreases levels of ropinirole by pharmacodynamic antagonism. Contraindicated.

            • safinamide

              metoclopramide decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

            • sertraline

              metoclopramide and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • venlafaxine

              metoclopramide and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • vilazodone

              metoclopramide increases levels of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Strong CYP3A4 inhibitors may increase vilazodone plasma levels by 50% - Reduce daily dose to 20 mg.

            Monitor Closely (37)

            • amoxapine

              amoxapine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              metoclopramide and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • apomorphine

              metoclopramide decreases levels of apomorphine by pharmacodynamic antagonism. Use Caution/Monitor. Avoid combination if possible.

            • aripiprazole

              aripiprazole and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • benperidol

              benperidol and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • bromocriptine

              metoclopramide decreases levels of bromocriptine by pharmacodynamic antagonism. Use Caution/Monitor. Avoid combination if possible.

            • bupivacaine implant

              metoclopramide, bupivacaine implant. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • chlorpromazine

              chlorpromazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • clobazam

              metoclopramide, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clozapine

              clozapine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • cyclosporine

              metoclopramide increases levels of cyclosporine by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • deutetrabenazine

              metoclopramide and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.

            • digoxin

              metoclopramide decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • droperidol

              droperidol and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • fluphenazine

              fluphenazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • haloperidol

              haloperidol and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • iloperidone

              iloperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • levodopa

              metoclopramide decreases levels of levodopa by pharmacodynamic antagonism. Use Caution/Monitor. Avoid combination if possible.

            • loxapine

              loxapine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, metoclopramide. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • olanzapine

              olanzapine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • oxybutynin

              oxybutynin decreases effects of metoclopramide by pharmacodynamic antagonism. Use Caution/Monitor. May antagonize prokinetic effects.

            • oxybutynin topical

              oxybutynin topical decreases effects of metoclopramide by pharmacodynamic antagonism. Use Caution/Monitor. May antagonize prokinetic effects.

            • oxybutynin transdermal

              oxybutynin transdermal decreases effects of metoclopramide by pharmacodynamic antagonism. Use Caution/Monitor. May antagonize prokinetic effects.

            • paliperidone

              paliperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • perphenazine

              perphenazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • pimozide

              pimozide and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • posaconazole

              metoclopramide decreases levels of posaconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • prochlorperazine

              prochlorperazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • promethazine

              promethazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • quetiapine

              quetiapine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • risperidone

              risperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • tetrabenazine

              metoclopramide and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • thioridazine

              thioridazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • thiothixene

              thiothixene and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • ziprasidone

              ziprasidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            Minor (8)

            • acetaminophen

              metoclopramide increases levels of acetaminophen by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • acetaminophen IV

              metoclopramide increases levels of acetaminophen IV by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • acetaminophen rectal

              metoclopramide increases levels of acetaminophen rectal by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • atovaquone

              metoclopramide decreases levels of atovaquone by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • ethanol

              metoclopramide increases effects of ethanol by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Increased CNS depression.

              metoclopramide increases effects of ethanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • fosfomycin

              metoclopramide decreases levels of fosfomycin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • meperidine

              metoclopramide increases effects of meperidine by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Increased CNS depression.

              metoclopramide increases effects of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • nitrofurantoin

              metoclopramide decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Extrapyramidal symptoms (dystonic reactions in 25% of young adults 18-30 years old)

            1-10%

            Fatigue (2-10%)

            Restlessness (10%)

            Sedation (10%)

            Headache (4-5%)

            Dizziness (1-4%)

            Somnolence (2-3%)

            Frequency Not Defined

            Diarrhea

            Nausea

            Galactorrhea

            Gynecomastia

            Impotence

            Menstrual disorders

            Neuroleptic malignant syndrome

            Hematologic abnormalities

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            Warnings

            Black Box Warnings

            May cause tardive dyskinesia (often irreversible)

            Risk of developing tardive dyskinesia increases with treatment duration and total cumulative dose

            Discontinue with signs or symptoms of tardive dyskinesia

            No known treatment exists for tardive dyskinesia

            Symptoms may lessen or resolve after metoclopramide treatment is stopped

            Do not administer for longer than 12 weeks, except in rare cases where therapeutic benefit is thought to outweigh risk of tardive dyskinesia

            Contraindications

            Hypersensitivity to metoclopramide or procainamide

            History of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide

            When stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation)

            Presence of pheochromocytoma or other catecholamine-releasing paragangliomas

            Patients with history of epilepsy

            Other drugs causing extrapyramidal symptoms (eg, phenothiazines, butyrophenones)

            Cautions

            Mental depression reported; use with caution in patients with history of mental illness

            Use with caution or avoid in Parkinson disease patients; may have increased risk of extrapyramidal symptoms

            Use with caution after GI anastomosis or closure; promotility agents reported to increase pressure in suture lines

            Use caution in patients with hypertension, CHF, renal impairment, cirrhosis

            Use caution in patients who are at risk of fluid overload

            Metoclopramide may cause a potentially fatal symptom complex called neuroleptic malignant syndrome (NMS). NMS has been reported in association with metoclopramide over dosage and concomitant treatment with another drug associated with NMS; discontinue therapy immediately if symptoms occur

            Can cause tardive dyskinesia (see Black Box Warnings), especially in elderly; discontinue if signs or symptoms of tardive dyskinesia develop (metoclopramide itself may completely or partially suppress these manifestations); tardive dyskinesia may persist even after drug is discontinued

            As with other dopamine D2 receptor antagonists, metoclopramide elevates prolactin levels

            Galactorrhea, amenorrhea, gynecomastia, and impotence reported with prolactin-elevating drugs, including metoclopramide; hyperprolactinemia may potentially stimulate prolactin-dependent breast cancer; however, some clinical studies and epidemiology studies have not shown an association between administration of dopamine D2 receptor antagonists and tumorigenesis in humans

            May impair mental and/or physical abilities required for performance of hazardous tasks such as operating machinery or driving a motor vehicle; concomitant use of central nervous system (CNS) depressants or drugs associated with EPS may increase this effect (e.g., alcohol, sedatives, hypnotics, opiates, and anxiolytics); avoid drug or the interacting drug, depending on importance of drug to the patient

            Diphenhydramine 50 mg IM can be given for extrapyramidal symptoms

            Pseudoparkisonism (eg, tremor, rigidity) may occur within 6 months of therapy; reversible within 2-3 months of discontinuing therapy

            Metoclopramide IV administration associated with catecholamine release; use caution in patients with hypertension

            Hypertensive crisis reported in patients with undiagnosed pheochromocytoma; discontinue therapy immediately with any sudden increase in blood pressure during therapy

            May cause QT prolongation and torsades de pointes in some patients with heart failure patients that also have renal impairment; data on healthy males have failed to show similar effects; implications unclear; use caution in cardiovascular disease

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            Pregnancy & Lactation

            Pregnancy

            Published studies, including retrospective cohort studies, national registry studies, and meta-analyses, do not report an increased risk of adverse pregnancy-related outcomes with use of metoclopramide during pregnancy. There are potential risks to neonate following exposure in utero to metoclopramide during delivery; in animal reproduction studies, no adverse developmental effects were observed with oral administration of metoclopramide to pregnant rats and rabbits at exposures about 6 and 12 times the maximum recommended human dose (MRHD)

            Metoclopramide crosses the placental barrier and may cause extrapyramidal signs and methemoglobinemia in neonates with maternal administration during delivery; monitor neonates for extrapyramidal signs

            Lactation

            Limited published data report the presence of metoclopramide in human milk in variable amounts; breastfed infants exposed to metoclopramide have experienced gastrointestinal adverse reactions, including intestinal discomfort and increased intestinal gas formation; metoclopramide elevates prolactin levels; however, published data are not adequate to support drug effects on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition

            Monitor breastfeeding neonates because metoclopramide may cause extrapyramidal signs (dystonias) and methemoglobinemia

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Blocks dopamine receptors (at high dose) and serotonin receptors in chemoreceptor trigger zone of CNS; and sensitizes tissues to acetylcholine; increases upper GI motility but not secretions; increases lower esophageal sphincter tone

            Absorption

            Bioavailability: IM, 74-96%; PO, 65-95%

            Onset: 1-3 min (IV, ); 10-15 min (IM); 30-60 min (PO)

            Duration: 1-2 hr regardless of route

            Peak serum time: IV, 15 min; PO, 60-120 min

            Distribution

            Protein bound: 30-40%

            Vd: 3.5 L/kg

            Metabolism

            Metabolized by liver

            Metabolites: Metoclopramide glucuronides, metoclopramide sulfates, aminoacetic acid (inactive)

            Elimination

            Half-life (IV/IM): 5-6hr (adults); 4 hr (children)

            Dialyzable: Not significant; dose adjustment after dialysis unnecessary

            Total body clearance: 0.53-0.55 L/hr/kg (prolonged in neonates as compared with adults)

            Excretion: Primarily urine (85%)

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            Administration

            IV Incompatibilities

            Solution: D5W (at high drug concentration)

            Additive: Dexamethasone sodium phosphate with lorazepam and diphenhydramine, erythromycin lactobionate, floxacillin, fluorouracil, furosemide

            Syringe: Ampicillin, calcium gluconate, chloramphenicol sodium succinate, furosemide, methotrexate, penicillin G potassium, sodium bicarbonate

            Y-site: Allopurinol, amphotericin B cholesteryl sulfate, amsacrine, cefepime, doxorubicin liposomal, furosemide, propofol

            IV Compatibilities

            Additive: Cimetidine, clindamycin, meperidine, meropenem, morphine sulphate, potassium chloride, verapamil

            Syringe (partial list): Butorphanol, chlorpromazine, cisplatin, cyclophosphamide, cytarabine, dexamethasone, dimenhydrinate, diphenhydramine, doxorubicin, fentanyl, fentanyl with midazolam, fluorouracil, heparin, hydromorphone, hydroxyzine, insulin, lidocaine, magnesium sulfate, meperidine, midazolam, morphine, ondansetron, pentazocine, prochlorperazine, promethazine, ranitidine, vitamins B and C

            Y-site (partial list): Aztreonam, bivalirudin, ciprofloxacin, cisplatin, cytarabine, diltiazem, docetaxel, doxorubicin, famotidine, fentanyl, fluconazole, fluorouracil, heparin, hydromorphone, linezolid, meperidine, morphine sulfate, ondansetron, quinupristin-dalfopristin, zidovudine

            IV Administration

            NS is preferred diluent because drug is most stable in this solution

            Dose ≤10 mg: IV push over 1-2 minutes

            Dose >10 mg: Dilute in 50 mL D5W or NS, and infuse over at least 15 minutes

            Protect from light

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            metoclopramide oral
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            10 mg tablet
            metoclopramide oral
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            10 mg tablet
            metoclopramide oral
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            5 mg/5 mL solution
            metoclopramide oral
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            10 mg tablet
            metoclopramide oral
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            10 mg tablet
            metoclopramide oral
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            5 mg tablet
            metoclopramide oral
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            5 mg tablet
            metoclopramide oral
            -
            10 mg tablet
            metoclopramide oral
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            5 mg/5 mL solution
            metoclopramide oral
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            5 mg tablet
            metoclopramide oral
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            5 mg tablet
            metoclopramide oral
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            5 mg tablet
            metoclopramide oral
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            5 mg tablet
            metoclopramide oral
            -
            10 mg tablet
            Reglan oral
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            10 mg tablet
            Reglan oral
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            5 mg tablet
            metoclopramide injection
            -
            5 mg/mL vial
            metoclopramide injection
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            5 mg/mL vial
            metoclopramide injection
            -
            5 mg/mL solution
            metoclopramide injection
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            5 mg/mL vial
            metoclopramide injection
            -
            5 mg/mL vial
            metoclopramide injection
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            5 mg/mL vial

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            Patient Handout

            Select a drug:
            Patient Education
            metoclopramide oral

            METOCLOPRAMIDE - ORAL

            (MET-oh-KLOE-pra-mide)

            COMMON BRAND NAME(S): Reglan

            WARNING: This medication may cause a serious movement disorder called tardive dyskinesia. In some cases, this condition may be permanent. The risk of tardive dyskinesia is increased with the longer use of the medication and the more medication that you take. The risk is also increased in older adults (especially women) and in people with diabetes. Metoclopramide comes in different forms (such as tablets, solution, injection). Do not use metoclopramide products for longer than 12 weeks. Talk to your doctor about the risks and benefits of this medication.Tell your doctor right away if you develop any unusual uncontrolled movements (especially of the face, mouth, tongue, arms or legs). There is no treatment for tardive dyskinesia, but in some cases the symptoms may lessen or stop once metoclopramide is stopped.

            USES: This medication is used to treat certain conditions of the stomach and intestines. Metoclopramide is used as a short-term treatment (4 to 12 weeks) for persistent heartburn when the usual medicines do not work well enough. It is used mostly for heartburn that occurs after a meal or during the daytime. Treating persistent heartburn can decrease the damage done by stomach acid to the swallowing tube (esophagus) and help healing.Metoclopramide is also used in diabetic patients who have poor emptying of their stomachs (gastroparesis). Treating gastroparesis can decrease symptoms of nausea, vomiting, and stomach/abdominal fullness. Metoclopramide works by blocking a natural substance (dopamine). It speeds up stomach emptying and movement of the upper intestines.This drug is not recommended for use in children due to an increased risk of serious side effects (such as muscle spasms/uncontrolled muscle movements). Ask the doctor or pharmacist for details.

            HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start taking metoclopramide and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually up to 4 times daily (30 minutes before meals and at bedtime). If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition, response to treatment, age, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Because of the risk of tardive dyskinesia, do not take this more often, in larger doses, or for longer than directed by your doctor.If heartburn only occurs at certain times (such as after the evening meal), your doctor may direct you to take a single dose before those times instead of taking it throughout the day. This will reduce your risk of side effects.To treat diabetic gastroparesis, this medication is usually taken for 2 to 8 weeks until your gut is working well. This condition may recur from time to time. Your doctor may direct you to start taking this medication as soon as your symptoms reappear and stop when you feel better. Ask your doctor for directions for starting and stopping this medication.Take this medication regularly as directed to get the most benefit from it. To help you remember, take it at the same times before a meal each day.If you suddenly stop using this medication, you may have withdrawal symptoms (such as dizziness, nervousness, headaches). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used metoclopramide for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.Tell your doctor if your condition persists or worsens.

            SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, tiredness, trouble sleeping, agitation, headache, and diarrhea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as anxiety, confusion, depression, thoughts of suicide), decreased sexual ability, inability to keep still/need to pace, muscle spasms/uncontrolled muscle movements (such as twisting neck, arching back), Parkinson-like symptoms (such as shaking, slowed/difficult movement, mask-like facial expression), abnormal breast-milk production, enlarged/tender breasts, swelling of the hands/feet, changes in menstruation in women.This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness, severe confusion, sweating, fast/irregular heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking metoclopramide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before taking this medication, tell your doctor or pharmacist your medical history, especially of: history of movement/muscle disorders (such as tardive dyskinesia, dystonia) caused by a medication, bleeding/blockage/hole in the intestines/stomach, breast cancer, high blood pressure, kidney problems, heart failure, mental/mood problems (such as depression, thoughts of suicide), Parkinson's disease, liver problems (such as cirrhosis, porphyria), pheochromocytoma, seizures, a certain blood enzyme problem (NADH-cytochrome b5 reductase deficiency).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Liquid products may contain alcohol. Caution is advised if you have diabetes, alcohol dependence, liver disease, or any other condition that requires you to limit alcohol. Ask your doctor or pharmacist about using this product safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If you have diabetes, this product may make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have high or low blood sugar. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Children may be more sensitive to the side effects of this drug, especially muscle spasms/uncontrolled muscle movements. See also Uses section.Older adults may be more sensitive to the effects of this drug, especially drowsiness, tardive dyskinesia, and Parkinson's type muscle problems. Drowsiness can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: antipsychotic drugs (such as aripiprazole, haloperidol), atovaquone, dopamine agonists (such as cabergoline, pergolide, ropinirole), fosfomycin, MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), pramlintide, phenothiazines (such as promethazine, prochlorperazine), rivastigmine.Metoclopramide causes food and medication to move through your stomach more quickly, which may affect the absorption of some drugs. Talk to your doctor or pharmacist to see if any of the drugs that you are taking may be affected.Tell your doctor or pharmacist if you are taking other products that cause drowsiness, including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as endoscopy for ulcer) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised September 2020. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.