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- What is metoclopramide, and how does it work (mechanism of action)?
- What brand names are available for metoclopramide?
- Is metoclopramide available as a generic drug?
- Do I need a prescription for metoclopramide?
- What are the side effects of metoclopramide?
- What is the dosage for metoclopramide?
- Which drugs or supplements interact with metoclopramide?
- Is metoclopramide safe to take if I'm pregnant or breastfeeding?
- What else should I know about metoclopramide?
What is metoclopramide, and how does it work (mechanism of action)?
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.
What brand names are available for metoclopramide?
Reglan, Metozolv ODT, (Reglan ODT, Octamide, and Maxolon are discontinued)
What are the side effects of metoclopramide?
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 are:
Other important side effects of metoclopramide include serious neurological symptoms that mimic Parkinson's disease such as:
- 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.
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What is the dosage for metoclopramide?
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.
Which drugs or supplements interact with metoclopramide?
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.
Is metoclopramide safe to take if I'm pregnant or breastfeeding?
The safety of metoclopramide in pregnancy has not been established.
Metoclopramide is excreted in human breast milk. Nursing mothers should avoid metoclopramide during pregnancy.
What else should I know about metoclopramide?
What preparations of metoclopramide are available?
- Tablets: 5 and 10 mg.
- Syrup: 5 mg/5 ml.
- Injection: 5 mg/ml
How should I keep metoclopramide stored?
Tablets and syrup should be stored between 15 C - 30 C (59 F - 86 F). Injectable metoclopramide should be stored at room temperature 20 C - 25 C (68 F - 77 F).
Reference: FDA Prescribing Information
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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. Signs and symptoms of esophagitis include:
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- Chest pain
- Bad breath
- Sore throat
- Difficulty swallowing
Treatment of esophagitis includes diet, lifestyle changes, and medication depending upon the cause.
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Gastroesophageal Reflux Disease (GERD)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:
- regurgitation, and
GastroparesisGastroparesis 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.
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- certain medications,
- eating or drinking too much,
- spicy foods,
- diseases or conditions that irritate the nerves controlling the diaphragm,
- brain tumors,
- liver failure, and
- noxious fumes.
There are a variety of home remedies and treatments that can be used to get rid of hiccups.
Intestinal Gas (Belching, Bloating, Flatulence)
Gas (intestinal gas) means different things to different people. Everyone has gas and eliminates it by belching, burping, or farting (flatulence). Bloating or abdominal distension is a subjective feeling that the stomach is larger or fuller than normal. Belching or burping occurs when gas is expelled from the stomach out through the mouth. Flatulence or farting occurs when intestinal gas is passed from the anus.
Causes of belching or burping include
- drinking too rapidly,
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- swallowing air.
Causes of bloating or distension include
- fluid within the gastrointestinal (GI) tract, and
Causes of gas or flatulence are diseases such as
- sugary foods and drinks,
- fruits and vegetables,
- starches (wheat, oats, corn, and potatoes),
- lactose intolerance,
- untreated celiac disease, and
Treatment for excessive intestinal gas depends on the cause.
Irritable Bowel Syndrome (IBS)
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- Abdominal pain
- Increased gas (flatulence)
- Abdominal cramping
- Food intolerance
Two new tests are now available that may help diagnose irritable bowel syndrome with diarrhea and constipation (IBS-M) and irritable bowel syndrome with diarrhea (IBS-D). Treatment for IBS includes diet changes, medications, and other lifestyle changes to manage symptoms.
Migraine headaches are severe headaches that are sensitive to light, sounds, and smells. Some people who suffer from migraines also have severe head pain. People also have symptoms of nausea and vomiting. Common migraine triggers may include:
- Certain foods
- Changes in barometric pressure
- Other phenomenon
They are diagnosed by a doctor if the headache pattern fits established migraine headache criteria. Over-the-counter (OTC) and prescription medications are sometime used to treat acute migraines. To prevent or reduce the frequency and severity of them doctors recommend supplements and prescription medications, for example:
- Blood pressure drugs
- Anti-seizure drugs
Lifestyle modification helps in migraine management. Many people who suffer from migraines get relief from their condition by keeping a headache diary, identifying and avoiding triggers, and taking appropriate medication.