about Metoclopramide class, uses, side effects contraindications
Metoclopramide
Short Description
Metoclopramide has a direct effect on the digestive system, as it works by accelerating the movement of food through the stomach and intestines by increasing the contractions of the muscles of the upper digestive tract.
Category
Chemical class: Benzamide
Therapeutic class: Antiemetic, upper GI stimulant
Pregnancy category: B
Indications
To treat diabetic gastroparesis
ORALL
, CONCENTRATE, Adults and adolescents.10 mg 30 min before meals and at bedtime up to q.i.d. I.V.OR
I.M.INJECTION Adults and adolescents.10 mg t.i.d. or q.i.d. for severe symptoms; dosage adjusted as needed. To treat gastroesophageal reflux disease
ORALL
, CONCENTRATE, Adults and adolescents. 10 to 15 mg 30 min before meals and at bedtime. To prevent chemotherapy-induced vomiting
IV: Adults and adolescents. 3 mg/kg before chemotherapy and then 0.5 mg/kg/hr for 8 hr.
I.V.INJECTION Adults and adolescents. 1 to 2 mg/kg 30 min before chemotherapy and then repeated every 2 to 3 hr, as needed. Children. 1 mg/kg as a single dose, repeated in 1 hr. Maximum: 2 mg/kg. To prevent postoperative nausea and vomiting
IM
Adults and adolescents.10 to 20 mg near end of procedure.
DOSAGE ADJUSTMENT Reduced by half if creatinine clearance is less than 40 ml/min/ 1.73 m2.
Mechanism of Action
Antagonizes the inhibitory effect of dopamine on GI smooth muscle. This causes gastric contraction, which promotes gasmetoclopramide hydrochloride 662 tric emptying and peristalsis, thus reducing gastroesophageal reflux. Metoclopramide also blocks dopaminergic receptors in the chemoreceptor trigger zone, preventing nausea and vomiting. Route Onset Peak Duration P.O. 30–60 min Unknown 1–2 hr I.V. 1–3 min Unknown 1–2 hr I.M. 10–15 min Unknown 1–2 hr
Incompatibilities
Don’t administer metoclopramide through same I.V. line as calcium gluconate, cephalothin sodium, chloramphenicol sodium, cisplatin, erythromycin lactobionate, furosemide, methotrexate, penicillin G potassium, or sodium bicarbonate.
Contraindications
Concurrent use of butyrophenones, phenothiazines, or other that may cause extrapyramidal reactions; GI hemorrhage, mechanical obstruction, or perforation; hypersensitivity to metoclopramide or its components; pheochromocytoma; seizure disorders
Interactions
anticholinergics, opioid analgesics: Possibly decreased metoclopramide effects apomorphine: Possibly decreased antiemetic effect of apomorphine, possibly increased CNS depression bromocriptine, pergolide: Possibly decreased therapeutic effects of these
cimetidine: Possibly decreased absorption and therapeutic effects of cimetidine
CNS depressants: Possibly increased CNS depression cyclosporine: Increased cyclosporine level digoxin: Decreased gastric digoxin absorption levodopa: Possibly decreased levodopa effects
MAO inhibitors: Increased risk of severe hypertension if patient has essential hypertension
mexiletine: Possibly faster mexiletene absorption succinylcholine: Possibly prolonged therapeutic action of succinylcholine
alcohol use: Risk of excessive sedation
Side Efect
CNS: Agitation, anxiety, depression, dizziness, drowsiness, extrapyramidal reactions (motor restlessness, parkinsonism, tardive dyskinesia), fatigue, headache, insomnia, irritability, lassitude, neuroleptic malignant syndrome, panic reaction, restlessness
CV: AV block, fluid retention, heart failure, hypertension, hypotension, supraventricular tachycardia
EENT: Dry mouth
ENDO: Galactorrhea, gynecomastia
GI: Constipation, diarrhea, nausea
GU: Menstrual irregularities
HEME: Agranulocytosis
SKIN: Rash
Other: Restless leg syndrome
Cautions
Use metoclopramide cautiously in patients with hypertension because it may increase catecholamine levels.
WARNING Watch closely for tardive dyskinesia, especially in the elderly, women, and patients with diabetes, because this serious adverse effect is often irreversible even after therapy stops. Therapy lasting longer than 12 weeks isn’t recommended because risk of tardive dyskinesia increases the longer the patient takes metoclopramide. Risk also has been linked to total cumulative dose so prescriber must take this into account when setting dosage. At first sign of involuntary movements of face, tongue, or limbs, notify prescriber and expect to discontinue drug. Monitor patient with NADH-cytochrome b5 reductase deficiency because metoclopramide increases risk of methemoglobinemia and sulfhemoglobinemia, and patient can’t receive methylene blue. Assess patient for signs of intestinal obstruction, such as abnormal bowel sounds, diarrhea, nausea, and vomiting, before administering metoclopramide. Notify prescriber if you detect them. For I.V. use, you need not dilute doses of 10 mg or less. Give drug over 1 to 2 minutes. For doses larger than 10 mg, dilute in 50 ml normal saline solution, half-normal (0.45) saline solution, D5W, or lactated Ringer’s solution and infuse over at least 15 minutes. Avoid rapid I.V. delivery because it may cause anxiety, restlessness, and drowsiness. metoclopramide hydrochloride 663 M
WARNING Notify prescriber if patient shows signs of toxicity, such as disorientation, drowsiness, and extrapyramidal reactions. Monitor patient, especially one with heart failure or cirrhosis, for possible fluid retention or volume overload due to transient increase in plasma aldosterone level. Monitor patient closely for neuroleptic malignant syndrome, a rare but potentially fatal disorder characterized by hyperthermia, muscle rigidity, altered level of consciousness, irregular pulse or blood pressure, tachycardia, diaphoresis, and arrhythmias. Store drug in a light-resistant container; discard if discolored or contains particulate. PATIENT SAFTY
Advise against activities that require alertness for about 2 hours after each dose. Urge patient to avoid alcohol and CNS depressants while taking metoclopramide. They may increase CNS depression. Tell patient to immediately report involuntary movements of face, eyes, tongue, or hands, including lip smacking, chewing, puckering of mouth, frowning, scowling, sticking out tongue, blinking, moving eyes, or shaking arms and legs. Explain that stopping metoclopramide may cause withdrawal symptoms that include dizziness, nervousness, and headache.
Trade Name & Company Name
effect of Metoclopramide in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. N/V are common during the 1st trimester. Metoclopramide effectively reduces the incidence and severity, but may be associated with an increased risk of preterm delivery. It is unclear whether this relationship is related to metoclopramide or to the underlying disease. The insufficient data on the safety of metoclopramide makes it a second-line agent for the treatment of hyperemesis or gastroesophageal reflux. Metoclopramide is highly effective controlling N/V during surgery in women undergoing cesarean section. It reduces gastric secretions but does not decrease the quantity of narcotics used to control pain postoperatively. In contrast, metoclopramide significantly reduces the duration of labor and the total PCA morphine requirements of women undergoing prostaglandin-induced abortion. To reduce 703 the risk of dystonia, patients may be premedicated with diphenhydramine. Metoclopramide is also helpful for the treatment of migraine, and enhances erythropoiesis in women with Diamond-Blackfan anemia. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Metoclopramide crosses the human placenta, though the kinetics remain to be elucidated. Its use in the 1st trimester does not appear to be associated with an increased risk of malformations, spontaneous abortions, or decreased fetal birth weight. Rodent studies are reassuring, revealing no evidence of teratogenicity or IUGR despite the use of doses higher than those used clinically. Breastfeeding
Metoclopramide transfer was examined in 18 women who were 8-12w postpartum. It was detected in all samples, typically with an M:P ratio >1. However, metoclopramide was found in only 1 of the 5 neonates studied. Exposure of the child ranged from 6-24 mcg/kg/day in the early puerperium to 1-13 mcg/kg/day in the late puerperium. These quantities are considerably less than the therapeutic dose of 500 mcg/kg/day recommended for children. Metoclopramide is said to augment milk production without altering the prolactin or sodium concentrations. However, one RCT in women delivered prematurely concluded it does not improve breast milk volume or the duration of breastfeeding.
the follwing drugs will increse Metoclopramide by inhepiting cyp450
abiraterone ; amiodarone ; bupropion ; celecoxib ; chlorpromazine ; cimetidine ; cinacalcet ; citalopram ; clemastine ; clobazam ; clomipramine ; cocaine ; diethyl-dithiocarbamate ; diphenhydramine ; disulfiram ; doxepin ; duloxetine ; escitalopram ; fluoxetine ; halofantrine ; haloperidol ; hydroxyzine ; levomepromazine ; lorcaserin ; methadone ; metoclopramide ; midodrine ; moclobemide ; panobinostat ; paroxetine ; perphenazine ; promethazine ; quercetin ; quinidine ; ritonavir ; rolapitant ; sertraline ; terbinafine (oral) ; ticlopidine ; tripelennamine ; vemurafenib ;
the follwing drugs will decrease Metoclopramide by inhancing cyp450
ethanol ; isoniazid ;
Catogary
Miscellaneous antiemeticsDrugs used to treat or prevent vomiting or the feeling of sickness (nausea) are known as antiemetics.
Vomiting is a reflex action for getting rid of harmful...
GI stimulants...
trad drugs based on Metoclopramide
| Gen name | Trade name | Catagory name |
| metoclopramide | Gimoti | GI stimulants |
| metoclopramide | Metozolv ODT | GI stimulants |
| metoclopramide | Metozolv ODT | Miscellaneous antiemetics |
| metoclopramide | Reglan | GI stimulants |
| metoclopramide | Reglan | Miscellaneous antiemetics |
| Metoclopramide | METAGLIZ 10 MG TAB | |
| Metoclopramide | METAGLIZ 10MG-5ML SOLUTION | |
| Metoclopramide | PREMOSAN 10MG INJECTION | |
| Metoclopramide | PREMOSAN ORAL DROPS 4MG-ML | |
| Metoclopramide | PREMOSAN SYRUP 5MG-5ML | |
| Metoclopramide | PRIMPERAN 5MG-ML 2ML-AMP. | |
| Metoclopramide | PRIMPERAN ADULT SUPP.?20MG | |
| Metoclopramide | PRIMPERAN CHILDREN SUPP. | |
| Metoclopramide | PRIMPERAN DROPS 0.1MG-DROP | |
| Metoclopramide | PYLOMID 10MG TAB | |
other drugs from same cataogory