Metoclopramide parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for injection containing metoclopramide (as the hydrochloride).
Drugs List
Therapeutic Indications
Uses
Nausea and vomiting
Nausea and vomiting following cancer chemotherapy or irradiation
Post-operative nausea and vomiting: prevention
Dosage
To avoid dystonic adverse reactions, adhere strictly to dosage recommendations, specially in children and young adults.
The MHRA has recommended that metoclopramide should only be prescribed for short term use (up to 5 days).
Adults
10 mg three times daily.
The maximum dose in 24 hours is 30 mg (or 0.5 mg per kg bodyweight).
Elderly
10 mg three times daily.
The maximum dose in 24 hours is 30 mg (or 0.5 mg per kg bodyweight).
Children
The MHRA recommends in children aged 1 to 18 years that metoclopramide should only be used as a second-line option for prevention of delayed chemotherapy-induced nausea and vomiting, and for treatment of established postoperative nausea and vomiting.
Children aged 1 to 18 years
The recommended dose is 0.1 to 0.15 mg per kg bodyweight up to three times a day. The maximum dose in 24 hours is 0.5 mg/kg bodyweight.
Children under 1 year
The MHRA state that the use of metoclopramide is contraindicated in children under 1 year.
Patients with Renal Impairment
There is an increased risk of extrapyramidal reactions.
Patients with Hepatic Impairment
There is an increased risk of extrapyramidal reactions.
Administration
For intramuscular and slow intravenous injection.
The MHRA recommends that intravenous doses should be administered as a slow bolus over at least 3 minutes to reduce the risk of adverse effects.
Contraindications
Children under 1 year
Breastfeeding
Epileptic disorder
Gastrointestinal haemorrhage
Gastrointestinal obstruction
Gastrointestinal perforation
Phaeochromocytoma
Within 4 days of gastrointestinal surgery
Precautions and Warnings
Atopy
Children aged 1 to 20 years
Elderly
Asthma
Cardiac conduction defects
History of depression
Hypertension
Parkinson's disease
Porphyria
Pregnancy
Severe hepatic impairment
Severe renal impairment
Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Administer IV injection slowly
Care in patients under 20 years to avoid dystonic reactions
Methaemoglobinaemia may develop with prolonged administration
Advise patient to report signs of elevated prolactin levels
Discontinue if patient develops neuroleptic malignant syndrome
Discontinue if red cell disorders occur
Not licensed for all indications in all age groups
Only recommended for short term use (up to 5 days)
Advise patient to avoid alcohol during treatment
If vomiting persists reassess for possibility of underlying disorders, e.g. cerebral irritation.
Body weight is the better guideline for dose rather than age.
Patients taking the drug for disorders associated with gastric emptying should be reviewed at an early stage for response to treatment.
Pregnancy and Lactation
Pregnancy
Use with caution in pregnancy.
Animal tests in mammalian species and clinical experience have not indicated teratogenicity. However the manufacturers advise caution due to the lack of adequate and controlled studies in pregnant women, and to avoid in the first trimester.
Briggs classifies the drug as compatible in pregnancy. Reports shown how metoclopramide has been used during all stages of pregnancy and no evidence of embryo, fetal, or newborn harm has been found in human and animal studies.
Schaefer recommends metoclopramide as the drug of choice during pregnancy for motility disturbances in the upper gastrointestinal tract.
Lactation
Metoclopramide is contraindicated during breastfeeding.
The manufacturer does not recommend breastfeeding whilst taking metoclopramide. Available data indicates metoclopramide is expressed in human breast milk in low levels, however the effects on the exposed infants are unknown. Treatment discontinuation should be considered.
Side Effects
Acute dystonias
Acute extrapyramidal dystonic reactions
Agitation
Akathisia
Altered consciousness
Anaphylactoid reaction
Anaphylaxis
Angioedema
Anxiety
Asystole
Bradycardia
Breast swelling
Breast tenderness
Bulbar type of speech
Cardiac arrest
Cardiac conduction disturbances
Confusion
Constipation
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyskinesia
Dyspnoea
Facial muscle spasm
Faintness
Fatigue
Galactorrhoea
Gynaecomastia
Headache
Heart block
Hyperpyrexia
Hypersensitivity reactions
Hypotension
Increase in muscle tone
Increased blood pressure (transient)
Increased prolactin
Inflammation (injection site)
Irritability
Methaemoglobinaemia
Muscle rigidity
Nausea
Neuroleptic malignant syndrome
Oculogyric crisis
Oedema
Oligomenorrhoea
Opisthotonos
Pruritus
Rash
Restlessness
Rhythmic protrusion of tongue
Sinus arrest
Sleeplessness
Spasm of extra-ocular muscles including oculogyric crises
Sulfaemoglobinaemia
Tardive dyskinesia
Tongue oedema
Tremor
Trismus
Unnatural positioning of head and shoulders
Urticaria
Visual disturbances
Weakness
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: October 2013
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com Accessed on October 18, 2013.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
MHRA Drug Safety Update August 2013
Available at: https://www.mhra.gov.uk
Last accessed: October 18, 2013
Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications https://www.medicinescomplete.com Accessed on October 18, 2013.
Summary of Product Characteristics: Maxolon injection. Amdipharm Mercury Company Limited. Revised September 2011
Summary of Product Characteristics: Metoclopramide 5mg/5ml solution for injection. Amdipharm Mercury Company Limited. Revised August 2012
Summary of Product Characteristics: Metoclopramide 5mg/ml injection. Hameln Pharmaceuticals Ltd. Revised January 2020.
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