Indications for Metoclopramide Injection:
Relief of symptoms associated with acute and recurrent diabetic gastroparesis when oral treatment is not feasible. Prophylaxis of nausea/vomiting associated with emetogenic cancer chemotherapy. Prophylaxis of post-op nausea/vomiting in circumstances where nasogastric suction is undesirable.
Diabetic gastroparesis (early manifestations): initiate with oral form; (severe symptoms): initiate with IM or IV inj. May give 10mg doses slowly by IV route over a 1–2 minute period. Administration up to 10 days may be needed, at which time oral form may be instituted. Prophylaxis of nausea/vomiting: administer by IV infusion slowly over at least 15mins; give 30mins before chemotherapy and repeat every 2hrs for 2 doses, then every 3hrs for 3 doses. If highly emetogenic drugs used alone or in combination (eg, cisplatin, dacarbazine): give 2mg/kg for initial 2 doses; if less emetogenic drugs: 1mg/kg per dose may suffice. For doses >10mg: dilute in 50mL of a parenteral soln. Prophylaxis of post-op nausea/vomiting: give by IM inj near the end of surgery. Usually 10mg, however, 20mg doses may be used. Renal impairment (CrCl <40mL/min): initiate at 50% of dose.
Metoclopramide Injection Contraindications:
History of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide. When stimulation of GI motility may be dangerous (eg, obstruction, perforation, or hemorrhage). Pheochromocytoma or other catecholamine-releasing paragangliomas. Epilepsy.
Metoclopramide Injection Warnings/Precautions:
Increased risk of TD with long-term use; avoid treatment >12 weeks. Diabetes mellitus. Discontinue if signs/symptoms of TD, extrapyramidal symptoms (EPS), parkinsonian symptoms, motor restlessness, or neuroleptic malignant syndrome (NMS) occurs. Avoid in Parkinson's disease, depression, hypertension. Cirrhosis. CHF. Renal or hepatic impairment. NADH-cytochrome b5 reductase deficiency. G6PD deficiency. CYP2D6 poor metabolizers. Elderly (esp. women). Neonates. Pregnancy. Nursing mothers: monitor infants.
Metoclopramide Injection Classification:
Dopamine-2 receptor antagonist.
Metoclopramide Injection Interactions:
Avoid concomitant drugs that can cause or potentially affect TD, EPS, or NMS (eg, antipsychotics). Potentiated by strong CYP2D6 inhibitors (eg, quinidine, bupropion, fluoxetine, paroxetine); reduce dose (see Adult). Increased risk of hypertension with MAOIs; avoid. Increased risk of CNS depression with alcohol, sedatives, hypnotics, opiates, anxiolytics. Antagonized by drugs that impair GI motility (eg, antidiarrheals, anticholinergics, opiates). Avoid concomitant dopaminergic drugs (eg, apomorphine, bromocriptine, levodopa, ropinirole). May potentiate succinylcholine, mivacurium, sirolimus, tacrolimus, cyclosporine; monitor and adjust dose. May antagonize digoxin (adjust dose), atovaquone, posaconazole (oral susp), fosfomycin; monitor. Concomitant insulin: monitor and adjust dose.
Restlessness, drowsiness, fatigue, lassitude; TD, EPS, parkinsonism, akathisia, seizures, hallucinations, NMS, hypertension (discontinue if occurs), fluid retention (discontinue if occurs), hyperprolactinemia, hypersensitivity reactions.
Generic Drug Availability:
Tabs—100; Single-use vial—contact supplier