Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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 cancerchemotherapy.
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.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Hiccups are a sudden, involuntary contraction of the diaphragm muscle. In general hiccups are just a temporary condition. Some of the causes of hiccups include certain medications, surgery, eating or drinking too much, spicy foods, diseases or conditions that irritate the nerves controlling the diaphragm, strokes, brain tumors, liver failure, and noxious fumes.
Gastroparesis is a medical condition in which the muscle of the stomach is paralyzed by a disease of either the stomach muscle itself or the nerves controlling the muscle. As a consequence, food and secretions do not empty normally from the stomach. Gastroparesis symptoms are nausea and vomiting; abdominal bloating, and pain can result.
Prolactinoma is an adenoma (benign tumor) of the pituitary gland. Causes of many prolactinomas are unknown. Symptoms in women include changes in menstruation and infertility, decreased libido, or painful intercourse due to vaginal dryness. The most common symptom in men is impotence (erectile dysfunction). Treatment of prolactinomas are medication or surgery.
It's important to know whether you will breastfeed or bottle-feed your baby prior to delivery, as the breasts' ability to produce milk diminishes soon after childbirth without the stimulation of breastfeeding. Breast milk is easily digested by babies and contains infection-fighting antibodies and cholesterol, which promotes brain growth. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. This article explores the advantages and disadvantages of both forms of feeding.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include:
Candida. This is a yeast infection of the esophagus caused by the same fungus that
causes vaginal yeast infections. The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetes or
HIV). It is usually very treatable with antifungal drugs.
Herpes. Like Candida, this viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.
Irritation causing esophagitis may be caused by any of the following:
GERD, or gastroesophageal reflux disease
Vomiting
Surgery
Medications such as aspirin and other anti-inflammatory drugs
Digestion RSS
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