Metoclopramide

Metoclopramide

[1 ampoule 45 cents]

ADMINISTRATION ROUTES:

• PO, IV

ALTERNATIVE NAMES:

• Maxolon, Metamide, Metoclopramide

ICU INDICATIONS:

1. nausea
2. gastroparesis

PRESENTATION AND ADMINISTRATION:

• PO:
  Maxalon 10mg tablets (white), Metamide 10mg tablets (white)
• IV:
  10mg/2ml ampoule
  Inject undiluted over 1-2 minutes
  Compatible with the following IV fluids:
  Normal saline, Glucose and sodium chloride, 5%dextrose, Hartmanns
  DO NOT USE if the solution is cloudy or precipitate is present
  Store at room temperature. Protect from light

DOSAGE:

• PO:
  10mg 6-8 hourly
• IV:
  10-20mg 6-8 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose in renal impairment [GFR (ml/min)]
  <10: 50-100% of normal dose
  10-20: 75-100% of normal dose
  >20-50: dose as in normal renal function

• Dose in renal replacement therapy
  CAPD: 50-100% of normal dose
  HD: 50-100% of normal dose
  CVVHDF: 75-100% of normal dose

DOSAGE IN PAEDIATRICS:

• PO/IV:
  0.15-0.30mg/kg 6-8 hourly

CLINICAL PHARMACOLOGY:

• The antiemetic properties of metoclopramide appear to be a result of its antagonism of central and peripheral dopamine receptors. Dopamine produces nausea and vomiting by stimulation of the medullary chemoreceptor trigger zone (CTZ), and metoclopramide blocks stimulation of the CTZ by agents like l-dopa or apomorphine which are known to increase dopamine levels or to possess dopamine-like effects. Metoclopramide stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. Its mode of action is unclear.

CONTRAINDICATIONS:

1. Parkinsons disease
2. hypersensitivity to metoclopramide
3. mechanical obstruction

WARNINGS

• Acute dystonic reactions
  Extrapyramidal symptoms, manifested primarily as acute dystonic reactions, occur in approximately 1 in 500 patients treated with the usual adult dosages of 30-40 mg/day of metoclopramide.
  These usually are seen during the first 24-48 hours of treatment with metoclopramide, occur more frequently in pediatric patients and adult patients less than 30 years of age and are even more frequent at the higher doses used in prophylaxis of vomiting due to cancer chemotherapy.
  These symptoms may include involuntary movements of limbs and facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, or dystonic reactions resembling tetanus. Rarely, dystonic reactions may present as stridor and dyspnea, possibly due to laryngospasm.
  If these symptoms should occur, Benztropine, 1-2 mg intramuscularly, may be used to reverse these reactions.
• Tardive Dyskinesia
  Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with metoclopramide.
• Neuroleptic Malignant Syndrome (NMS)
  There have been rare reports of an uncommon but potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) associated with metoclopramide.

PRECAUTIONS

• General:
  See WARNINGS
• Laboratory Tests:
  No tests in addition to routine ICU tests are required.
• Drug/Laboratory Test Interactions:
  None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• The effects of metoclopramide on gastrointestinal motility are antagonized by anticholinergic drugs and narcotic analgesics. Additive sedative effects can occur when metoclopramide is given with alcohol, sedatives, hypnotics, narcotics, or tranquilizers.

ADVERSE REACTIONS

• CNS Effects:
  Restlessness, drowsiness, fatigue, insomnia, headache, confusion, dizziness, depression, acute dystonic reactions, parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies, tardive dyskinesia, Neuroleptic Malignant Syndrome
• Endocrine Disturbances:
  Galactorrhea, amenorrhea, gynaecomastia, fluid retention
• Cardiovascular:
  Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure and possible AV block
• Gastrointestinal:
  Nausea and bowel disturbances, primarily diarrhea. hepatotoxicity,
• Renal:
  Urinary frequency and incontinence.
• Hematologic:
  neutropenia, leukopenia, or agranulocytosis, methemoglobinemia
• Allergic Reactions:
  A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.