Top 300 Pharmacy Drug Cards

METOCLOPRAMIDE: Reglan, Various

Class: Dopamine Antagonist

Dosage Forms. Tablet: 5 mg, 10 mg; Solution: 5 mg/5 mL; Dispersable Tablet: 5 mg, 10 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Diabetic gastroparesis: 10 mg po 30 min before meals and at bedtime for 2-8 wk; max 12 wk duration

2. Gastroesophageal reflux disease: Adults, 10-15 mg po qid 30 min before meals and at bedtime; Neonates, 0.15 mg/kg po q6h; Infants, 0.1 mg/kg po tid-qid 10-30 min before meals and at hs, max dose 0.3-0.75 mg/kg/d × 2 wk to 6 mo

Off-Label Uses.

1. Decreased lactation: 30-45 mg po daily × 7-15 d

2. Nondiabetic gastroparesis: 10 mg po 30 min before meals and at hs for 2-8 wk; max 12 wk duration

MOA. Metoclopramide stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. It is also a dopamine receptor antagonist.

Drug Characteristics: Metoclopramide

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Medication Safety Issues: Metoclopramide

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Drug Interactions: Metoclopramide

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Adverse Reactions: Metoclopramide

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Efficacy Monitoring Parameters. Reduction in nausea and vomiting.

Toxicity Monitoring Parameters. Seek medical attention if elevated blood pressure, heart palpitation, fluid retention, unusual bruising or bleeding, or involuntary jerking movements.

Key Patient Counseling Points. Take this medicine on an empty stomach, 30 min before each meal and at bedtime. Not for long-term use. If using the oral dispersible tablet, make sure your hands are dry. Place the tablet in your mouth. It should melt quickly. After the tablet has melted, swallow or take a drink of water.

Clinical Pearls. Extrapyramidal reactions may consist of torticollis, facial spasms, urinary retention, and tetanus-like reactions. Young patients receiving high doses are at increased risk. Most patients respond to anticholinergic agents such as benztropine. Tardive dyskinesia is reported with the use of metoclopramide tablets. The symptoms of tardive dyskinesia are characterized by involuntary movements of the tongue, face, mouth, or jaw.