Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: metoclopramide
BRAND NAME: Reglan, Octamide, Maxolon
DRUG CLASS AND MECHANISM: Metoclopramide is a "prokinetic" drug that
stimulates the muscles of the gastrointestinal tract including the muscles of
the lower esophageal sphincter, stomach, and small intestine by interacting with
receptors for acetylcholine and dopamine on gastrointestinal muscles and nerves.
The lower esophageal sphincter, located between the esophagus and the stomach,
normally prevents reflux of acid and other contents in the stomach from backing
up into the esophagus. In patients with gastroesophageal reflux disease (GERD),
a weakened lower esophageal sphincter allows reflux of stomach acid into the
esophagus, causing heartburn and damage to the esophagus (esophagitis).
Metoclopramide decreases the reflux of stomach acid by strengthening the muscle
of the lower esophageal sphincter. Metoclopramide also stimulates the muscles of
the stomach and thereby hastens emptying of solid and liquid meals from the
stomach and into the intestines.
In some patients, particularly those with
diabetes, damage to nerves in the stomach can interfere with function of the
muscles and cause delayed emptying of the stomach, resulting in nausea,
vomiting, a sense of abdominal fullness and distention, and heartburn (diabetic
gastroparesis). Metoclopramide can be effective in relieving the symptoms
related to diabetic gastroparesis by stimulating more rapid emptying of the
stomach as well as decreasing the reflux of stomach acid into the esophagus.
Dopamine receptors on nerves in the brain are important in producing nausea.
Metoclopramide interacts with the dopamine receptors in the brain and can be
effective in treating nausea. The FDA approved metoclopramide in June 1985.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:
- Tablets: 5 and 10 mg.
- Syrup: 5 mg/5 ml.
- Injection: 5 mg/ml
STORAGE: Tablets and syrup should be stored between 15-30 C (59-86 F).
Injectable metoclopramide should be stored at room temperature 20-25 C (68-77
F).
PRESCRIBED FOR: Metoclopramide is used on a short term basis (4 to 12
weeks) for treating patients with heartburn and esophagitis due to GERD and for
treating patients who have gastroparesis. Metoclopramide is used to promote
emptying of the stomach prior to radiological examinations and to facilitate
passage of tubes passed through the nose or mouth and into the small intestine.
It is used for treating impaired function of muscles of the small intestine that
may give rise to symptoms that mimic intestinal obstruction (nausea, vomiting,
and abdominal distention). Metoclopramide also is used in the treatment of
nausea due to surgery or cancer
chemotherapy.
DOSING:
The usual dose of metoclopramide for treating GERD is 10-15 mg
four times daily, 30 minutes before each meal.
Gastroparesis is treated with 10
mg administered orally four times daily, 30 minutes before each meal and at
bedtime.
DRUG INTERACTIONS: Since metoclopramide accelerates emptying of the
stomach, it can increase or decrease 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. Conversely, metoclopramide may decrease the concentrations in
blood 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), because of the risk of serious adverse effects due to excess release
of neurotransmitters. Concurrent administration of anticholinergic drugs can
decrease the effectiveness of metoclopramide.
PREGNANCY: The safety of metoclopramide in
pregnancy has not been
established.
NURSING MOTHERS: Metoclopramide is excreted in human
breast milk.
Nursing mothers should avoid metoclopramide during pregnancy.
SIDE EFFECTS: Metoclopramide is generally well-tolerated when used in
low doses for brief periods. Neurological side effects increase with higher
doses and longer periods of treatment. Common side effects of metoclopramide
include drowsiness, restlessness, fatigue, anxiety, insomnia, depression,
and sedation. The most serious neurological side effects of
metoclopramide are symptoms mimicking Parkinson's disease, involuntary muscle
movements, facial grimacing, and dystonic reactions resembling tetanus.
Fortunately, these more serious side effects are infrequent and usually - though
not always - disappear when metoclopramide is discontinued. Patients with
Parkinson's disease can experience worsening of symptoms with metoclopramide.
Metoclopramide may impair the mental and/or physical abilities to drive or
operate machinery.
Reference: FDA Prescribing Information
Last Editorial Review: 9/15/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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