Drug reference

Metoclopramide

Prokinetic · Antiemetic

Also known as Metoclopramide hydrochloride

ProkineticAntiemeticATC A03FA01

CDSCO approvedSchedule HATC A03FA01

Pharmacokineticsplasma · t hours

ONSET: 45min · 30 to 60 min (oral); 10 to 15 min (IM); 1 to 3 min (IV)
PEAK: 1h · Within 1 h (oral)
t½: 5h · 4 to 6 h
DURATION: 5h · 4–6 hours

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

FDA category + note

Top interactionssee all 12 →

LevodopaContraindicatedTextbook-citedKDT 7e · p950
AlimemazineSevereDatabaseDDInter
AmisulprideSevereDatabaseDDInter
AmoxapineSevereDatabaseDDInter

Mechanism

Metoclopramide has a prokinetic action. Drugs with antimuscarinic effects antagonise prokinetic drugs.

Indications

Hiccup due to gastric distension (if other measures fail)Nausea and vomiting with opioid therapy (initial stages)Nausea and vomiting associated with gastritisNausea and vomiting associated with gastric stasisNausea and vomiting associated with functional bowel obstructionNauseaVomitingprevention of nausea and vomiting (in combination with droperidol and dexamethasone)GastroparesisAdjunctive measure in medical or diagnostic GI procedures (upper endoscopy, contrast radiography)Amelioration of nausea and vomiting accompanying GI dysmotility syndromes (e.g., gastroparesis)Prevention of cisplatin-induced delayed emesisEmesis failing first-line treatmentsGastroesophageal reflux disease (GERD) (for relief of regurgitation and heartburn)postoperative vomitingdrug induced vomitingdisease associated vomiting (especially migraine)radiation sicknesschemotherapy induced nausea and vomiting (CINV)accelerate gastric emptying (when emergency general anaesthesia has to be given, postvagotomy or diabetic gastroparesis, to facilitate duodenal intubation)dyspepsia and other functional g.i. disorders (persistent hiccups)milder cases of gastroesophageal reflux disease (GERD)morning sickness (only when not controlled by other measures)Prevention of chemotherapy-induced nausea and vomiting (highly and moderately emetogenic regimens)

Dosing

Adult: subcutaneous infusion rates are so slow (0.1– 0.3 mL/hour). by subcutaneous infusion in a strength of up to 250 mg/mL;. up to a strength of 40 mg/mL either water for injections or. 10 mg/mL or in the presence of sodium chloride 0.9% or. concentration is above 2 mg/mL.
Pediatric: Not recommended for children for GERD due to safety concerns and limited efficacy
Max dose: 40 mg/day for prokinetic use

Pharmacokinetics

Onset

30 to 60 min (oral); 10 to 15 min (IM); 1 to 3 min (IV)

Peak effect

Within 1 h (oral)

Duration

4–6 hours

Half-life

4 to 6 h

Bioavailability

76 ± 38%

Protein binding

Not specified

Metabolism

Sulfation and glucuronide conjugation by the liver

Excretion

Principally in the urine

Contraindications

Concurrent use with antimuscarinic drugs
Not particularly useful for the treatment of refractory GERD
gastroesophageal reflux disease (GERD) in children

Side effects

Common

Skin reactionsExtrapyramidal effects (dystonias, parkinsonian-like symptoms)AnxietyDepressionGalactorrheagynaecomastiasedationdizzinessloose stoolsmuscle dystonias (especially in children)

Serious