Therapeutic Classification: antiemetics
Absorption: Well absorbed from the GI tract, from rectal mucosa, and from IM sites. 47% absorbed following intranasal administration. IV administration results in complete bioavailability.
Distribution: Widely distributed into body tissues and fluids. Crosses blood-brain barrier.
Metabolism/Excretion: Partially metabolized by the liver via the CYP2D6 isoenzyme; the CYP2D6 isoenzyme exhibits genetic polymorphism (∼7% of population may be poor metabolizers and may have significantly ↑ metoclopramide concentrations and an ↑ risk of adverse effects). 25% eliminated unchanged in the urine.
Half-Life: 2.5–6 hr.
Prevention of Chemotherapy-Induced Nausea and Vomiting
- IV (Adults and Children ): 1–2 mg/kg 30 min before chemotherapy. Additional doses of 1–2 mg/kg may be given every 2–4 hr, pretreatment with diphenhydramine will ↓ the risk of extrapyramidal reactions to this dose.
Facilitation of Small Bowel Intubation
- IV (Adults and Children >14 yr): 10 mg over 1–2 min.
- IV (Children 6–14 yr): 2.5–5 mg (dose should not exceed 0.5 mg/kg) over 1–2 min.
- IV (Children <6 yr): 0.1 mg/kg over 1–2 min.
Diabetic Gastroparesis
- PO IV IM (Adults ): 10 mg 30 min before meals and at bedtime for 2–8 wk (not to exceed 40 mg/day). CYP2D6 poor metabolizers: 5 mg 30 min before meals and at bedtime for 2–8 wk (not to exceed 20 mg/day). Concurrent use of strong CYP2D6 inhibitor: 5 mg 30 min before meals and at bedtime for 2–8 wk (not to exceed 20 mg/day).
- (Adults ): One spray (15 mg) in one nostril 30 min before each meal and at bedtime (not to exceed 60 mg/day) for 2–8 wk (not to exceed 12 wk).
- PO IV IM Geriatric Patients ): 5 mg 30 min before meals and at bedtime for 2–8 wk; may titrate up to 10 mg 30 min before each meal and at bedtime based on response and tolerability (not to exceed 40 mg/day).
- Geriatric Patients ): Patients receiving alternative metoclopramide product at stable dose of 10 mg four times daily: One spray (15 mg) in one nostril 30 min before each meal and at bedtime (not to exceed 60 mg/day) for 2–8 wk (not to exceed 12 wk).
Renal Impairment
- PO (Adults ): CCr ≤60 mL/min: 5 mg 30 min before meals and at bedtime for 2–8 wk (not to exceed 20 mg/day). End-stage renal disease (including hemodialysis and peritoneal dialysis): 5 mg twice daily for 2–8 wk (not to exceed 10 mg/day).
Hepatic Impairment
- PO IV IM (Adults ): Mild hepatic impairment: 10 mg 30 min before meals and at bedtime for 2–8 wk (not to exceed 40 mg/day). Moderate or severe hepatic impairment: 5 mg 30 min before meals and at bedtime for 2–8 wk (not to exceed 20 mg/day).
Gastroesophageal Reflux
- PO (Adults ): 10–15 mg 30 min before each meal and at bedtime (not to exceed 60 mg/day). CYP2D6 poor metabolizers: 5 mg 30 min before each meal and at bedtime or 10 mg 3 times daily (not to exceed 30 mg/day). Concurrent use of strong CYP2D6 inhibitor: 5 mg 30 min before each meal and at bedtime or 10 mg 3 times daily (not to exceed 30 mg/day).
- PO Geriatric Patients ): 5 mg 30 min before each meal and at bedtime; may titrate up to 10–15 mg 30 min before each meal and at bedtime based on response and tolerability (not to exceed 60 mg/day).
Renal Impairment
- PO (Adults ): CCr ≤60 mL/min: 5 mg 30 min before each meal and at bedtime or 10 mg 3 times daily (not to exceed 30 mg/day). End-stage renal disease (including hemodialysis and peritoneal dialysis): 5 mg 30 min before each meal and at bedtime or 10 mg twice daily (not to exceed 20 mg/day).
Hepatic Impairment
- PO (Adults ): Mild hepatic impairment: 10–15 mg 30 min before each meal and at bedtime (not to exceed 60 mg/day). Moderate or severe hepatic impairment: 5 mg 30 min before each meal and at bedtime or 10 mg 3 times daily (not to exceed 30 mg/day).
Prevention of Postoperative Nausea and Vomiting
- IM IV (Adults ): 10 mg at the end of surgical procedure, repeat in 6–8 hr if needed.
Treatment of Hiccups
- PO IM (Adults ): 10–20 mg 4 times daily PO; may be preceded by a single 10-mg dose IM.
