Metoclopramide: What is it? Side Effects, Dosage, Interaction and Presentations

It is a “prokinetic” drug that stimulates the muscles of the gastrointestinal tract, including the muscles of the lower esophageal sphincter, the stomach, and the small intestine.

This is achieved by interacting with the acetylcholine and dopamine receptors in the gastrointestinal muscles and nerves.

The lower esophageal sphincter, located between the esophagus and the stomach, usually prevents the reflux of acid and other contents in the stomach back into the esophagus.

In patients with gastroesophageal reflux disease (GERD), with a weakened lower esophageal sphincter there is permissiveness of stomach acid reflux into the esophagus, causing heartburn and damage to the esophagus ( esophagitis ).

This medication in this sense decreases the reflux of stomach acid by strengthening the lower esophageal sphincter muscle. Metoclopramide also stimulates the stomach muscles and speeds up the emptying of solid, liquid foods from the stomach to the intestines.

In some patients, particularly those with diabetes, damage to the nerves in the stomach can interfere with the function of the muscles and cause delayed emptying of the stomach, resulting in nausea, vomiting, fullness and bloating, and heartburn (diabetic gastroparesis).

It can be effective in relieving symptoms related to diabetic gastroparesis by stimulating a faster emptying of the stomach and by decreasing the reflux of stomach acid into the esophagus. Dopamine receptors in the nerves of the brain are important to produce nausea.

This medication interacts with dopamine receptors in the brain and may be effective in the treatment of nausea. The FDA approved metoclopramide in June 1985.

What brand names are available for metoclopramide?

Reglan, Metozolv ODT, (Reglan ODT, Octamide and Maxolon are discontinued)

Is it available as a generic medicine?

Yes, many laboratories have a generic version

Do I need a prescription for metoclopramide?

Yes, a recipe is needed.

What are the side effects?

Metoclopramide is generally well tolerated when used in low doses for short periods. Neurological side effects increase with higher doses and longer periods of treatment. The common side effects are:

  • Drowsiness.
  • Restlessness.
  • Fatigue.
  • Anxiety.
  • Insomnia.
  • Depression.
  • Sedation.

Other important side effects include severe neurological symptoms that mimic Parkinson’s disease, such as:

  • Involuntary movements of the muscles.
  • Make facial grimaces.
  • Dystonic reactions that resemble tetanus.

Fortunately, these more serious side effects are rare and usually, but not always, disappear when metoclopramide is discontinued.

Patients with Parkinson’s disease may experience a worsening of symptoms with metoclopramide. Metoclopramide can affect the mental and / or physical abilities to drive or operate machinery.

What is the recommended dosage?

The usual dose of metoclopramide to treat GERD is 10 to 15 mg four times a day, 30 minutes before each meal.

Gastroparesis is treated with 10 mg administered orally four times a day, 30 minutes before each meal and before going to bed.

What medications or supplements interact with metoclopramide?

Since metoclopramide accelerates the emptying of the stomach, it can increase or decrease the absorption and effects of other drugs that are absorbed in the small intestine.

For example, the effects of alcohol, diazepam (Valium) and cyclosporine can be accelerated when used together with metoclopramide. In contrast, metoclopramide may decrease blood concentrations of digoxin (Lanoxin) and cimetidine (Tagamet).

Metoclopramide should not be used in patients taking MAO inhibitors, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl) and procarbazine (Matulane), due to the risk of serious adverse effects due to excess release of neurotransmitters.

Concomitant administration of anticholinergic drugs may decrease the efficacy of metoclopramide.

Is it safe to take if I am pregnant or breastfeeding?

The safety of metoclopramide in pregnant women has not been established. What is known is that metoclopramide is excreted in human breast milk. Therefore, in this sense, mothers who are breastfeeding should avoid metoclopramide during pregnancy.

What preparations are available?

  • Tablets: 5 and 10 mg.
  • Jarabe: 5 mg / 5 ml.
  • Injection: 5 mg / ml.