Metoclopramide
Rx
Therapeutic ClassDopamine Antagonist
Clinical UseProkinetic & Antiemetic
Common Dose10 mg
PregnancyCategory B
Indications ▼
Nausea and vomiting (including chemotherapy-induced)
Diabetic gastroparesis
Gastroesophageal reflux disease (short-term)
Post-operative nausea and vomiting
Facilitation of small bowel intubation
Mechanism & Pharmacokinetics ▼
Mechanism: Metoclopramide blocks central and peripheral dopamine D₂ receptors and enhances acetylcholine release in the gastrointestinal tract. This increases gastric emptying, improves esophageal sphincter tone, and produces antiemetic action through chemoreceptor trigger zone inhibition.
Pharmacokinetics: Rapid oral absorption with peak plasma levels within 1–2 hours. Bioavailability ~80%. Crosses the blood–brain barrier. Metabolized in the liver. Elimination half-life approximately 5–6 hours. Excreted mainly via urine.
Dosage & Administration ▼
| Patient Group | Recommended Dose | Frequency |
|---|---|---|
| Adults | 10 mg | Up to 3–4 times daily |
| Maximum | 40 mg/day | Do not exceed |
| Children | 0.1–0.15 mg/kg | As prescribed |
Side Effects ▼
Drowsiness and fatigue
Restlessness and agitation
Diarrhea
Extrapyramidal symptoms (EPS)
Tardive dyskinesia with prolonged use
Hyperprolactinemia
Contraindications ▼
Parkinson’s disease
History of extrapyramidal reactions
Gastrointestinal obstruction or perforation
Pheochromocytoma
Hypersensitivity to metoclopramide
Drug Interaction ▼
Antipsychotics increase risk of EPS
Levodopa effect reduced
CNS depressants enhance sedation
Anticholinergics reduce prokinetic effect
Pregnancy & Lactation ▼
Generally considered safe during pregnancy
Used for severe nausea and vomiting of pregnancy
Excreted in breast milk; monitor infant
Clinical / Research Summary ▼
Therapeutic Role: Metoclopramide is a dopamine D2 receptor antagonist with prokinetic and antiemetic properties, commonly used to treat gastroparesis, nausea, vomiting, and gastroesophageal reflux disease (GERD).
Mechanism-Based Evidence: It stimulates gastrointestinal motility by blocking dopamine receptors in the gut and central chemoreceptor trigger zone (CTZ), enhancing gastric emptying and intestinal transit.
Clinical Effectiveness: Shown to be effective in postoperative nausea and vomiting, chemotherapy-induced nausea, diabetic gastroparesis, and functional dyspepsia.
Central Nervous System Considerations: Crosses the blood-brain barrier, which can cause extrapyramidal side effects such as dystonia, akathisia, and parkinsonism, especially in children and elderly patients.
Cardiac Safety: Rare cases of QT prolongation and arrhythmias reported; caution in patients with cardiac risk factors.
Regulatory Guidance: Recommended short-term use (usually ≤12 weeks) to minimize risk of tardive dyskinesia; dose adjustments needed in renal impairment.
Combination Therapy: May be used with antacids, proton pump inhibitors, or H2 blockers to improve reflux symptoms and gastric emptying.
Current Research Directions: Studies focus on safer dosing regimens, alternative delivery methods, and minimizing CNS-related adverse effects while maintaining prokinetic efficacy.
Patient Counseling Points ▼
Avoid long-term use without medical advice
Report involuntary movements immediately
May cause drowsiness; avoid driving
Take before meals if prescribed orally
Storage & Handling ▼
Store below 30°C
Protect from light and moisture
Keep out of reach of children
Brand Names (Bangladesh & Global) ▼
Medical Disclaimer: This information is intended for educational purposes only and does not replace professional medical advice.
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