BMA Concise Guide to Medicine & Drugs

Metoclopramide

Brand names Maxolon, Maxolon High Dose, Maxolon SR, Primperan

Used in the following combined preparation MigraMax

QUICK REFERENCE

Drug group Gastrointestinal motility regulator and anti-emetic drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Metoclopramide has a direct action on the gastrointestinal tract. It is used for conditions in which there is a need to encourage normal propulsion of food through the stomach and intestine.

The drug has powerful anti-emetic properties and its most common use is in the prevention and treatment of nausea and vomiting. It is particularly effective for the relief of the nausea that sometimes accompanies migraine headaches, and the nausea caused by treatment with anticancer drugs. It is also prescribed to alleviate symptoms of heartburn caused by acid reflux into the oesophagus.

One side effect of metoclopramide, muscle spasm of the head and neck, is more likely to occur in children and young adults under 20 years. Other side effects are not usually troublesome.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, SR tablets/capsules, liquid, powder, injection.

Frequency and timing of doses Usually 3 x daily; 2 x daily (SR preparations).

Adult dosage range Usually 15–30mg daily; may be higher for nausea caused by anticancer drugs.

Onset of effect Within 1 hour.

Duration of action 6–8 hours.

Diet advice Fatty and spicy foods and alcohol are best avoided if nausea is a problem.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 3 hours, take a single dose now and skip the next.

Stopping the drug Can be safely stopped as soon as you no longer need it.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. Large overdoses may cause drowsiness and muscle spasms. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Adverse effects are rare with metoclopramide. The main adverse effects are drowsiness and, even less commonly, uncontrolled muscle spasm. Other, very rare, adverse effects include restlessness, diarrhoea, muscle tremors and rigidity, and a rash. Consult your doctor if drowsiness is severe, and for all other effects. If you experience muscle spasms of the head or neck or develop a rash, stop taking the drug and consult your doctor urgently.

INTERACTIONS

Sedatives The sedative properties of metoclopramide are increased by all drugs that have a sedative effect on the central nervous system. These include benzodiazepines, antihistamines, antidepressants, and opioid analgesics.

Lithium Metoclopramide increases the risk of central nervous system side effects.

Ciclosporin Metoclopramide may increase the blood levels of this drug.

Drugs for parkinsonism There is an increased risk of adverse effects if these drugs are taken with metoclopramide.

Antipsychotics Metoclopramide increases the risk of adverse effects from these drugs.

Opioid analgesics and anticholinergic drugs These drugs oppose the gastrointestinal effects of metoclopramide.

Aspirin and paracetamol Metoclopramide increases the rate of absorption of these drugs.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have epilepsy.

· You have Parkinson’s disease.

· You have porphyria.

· You have phaeochromocytoma.

· You have stomach pains or cramps.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk but at normal doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Reduced dose necessary. Restricted use in patients younger than 20 years.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how metoclopramide affects you because the drug can cause drowsiness.

Alcohol Avoid. Alcohol may oppose the beneficial effects and increase the sedative effects of this drug.

PROLONGED USE

Not normally used long-term, except under specialist supervision for certain gastrointestinal disorders.