Adult Dosing
Diabetic gastroparesis (severe symptoms)
- 10 mg IM or IV over a 1-2 minute period; up to 10 days
Prophylaxis of nausea and vomiting; highly emetogenic chemotherapy
- Initial dose: 1-2 mg/kg IV given 30 min prior to chemotherapy
- Then repeat q2 hrs for 2 doses, then repeat q3 hrs for 3 doses
For the Prevention of Postoperative Nausea and Vomiting
- 10-20 mg IM near the end of surgical procedure
Small bowel intubation
- 10 mg IV over 1-2 min as a single dose
Radiolographic examination of upper GI tract
- 10 mg IV over 1-2 min as a single dose
Nausea and vomiting [Non-FDA Approved]
- 10 mg IV q4 hours as needed
Pediatric Dosing
Small bowel intubation
- <6 yrs: 0.1 mg/kg IV over 1-2 min as a single dose
- 6-14 yrs: 2.5-5 mg IV over 1-2 min as a single dose
- >14 yrs: 10 mg IV over 1-2 min as a single dose
Nausea and vomiting [Non-FDA Approved]
- 0.15 mg/kg (maximum 10 mg) IV q4 hours as needed
- Be aware of extrapyramidal symptoms, more common in children
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <40 mL/min: Reduce dose by 50%
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
See Supplemental Patient Information
- Duration of treatment and total cumulative dose are associated with an increased risk of developing tardive dyskinesia. Risk appears to be increased in the elderly, women, and diabetics; it is not possible to predict which patients will develop TD. Discontinue therapy in any patient if signs/symptoms appear [US Black Box Warning]
- Therapy with metoclopramide should not exceed 12 wks in duration [US Black Box Warning]
- Intense feeling of anxiety and restlessness, followed by drowsiness, may occur with rapid administration
- Abrupt discontinuation may result in withdrawal symptoms like dizziness, headache, nervousness
- Rare report of neuroleptic malignant syndrome (NMS) is associated with metoclopramide use; monitor for mental status changes, fever, muscle rigidity and/or autonomic instability; discontinue use if signs/symptoms appear
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Hx of depression
- NADH methemoglobin reductase deficiency
- Diabetes
- Hypertension
- Parkinson’s disease
- CHF
- Liver cirrhosis
- Neonates
- Pediatric population
- Geriatric population; especially women
Supplemental Patient Information
- May impair mental and/or physical abilities required for the performance of hazardous tasks such as operating machinery or driving a motor vehicle
Pregnancy Category:B
Breastfeeding: Safety Unknown; excreted in variable amounts in breast milk. Most infants would receive <10% of the maternal weight-adjusted dosage, but others can receive higher doses that can acheive pharmacologically active serum levels. This drug should be used with caution based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776) and LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 February 2011).
