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Metoclopramide

(meh-tuh-kloh-pruh-mide)

Trade/other name(s): Reglan, Metozolv

Why would this drug be used?

Metoclopramide is used to treat nausea and vomiting. It is also used for other purposes.

How does this drug work?

Metoclopramide is a dopamine receptor antagonist, which stops the relaxation of the stomach muscles. Its effects are different depending on the dosage size. At low doses, metoclopramide speeds emptying of the stomach, which reduces nausea and vomiting after chemotherapy since there's no food in the stomach. At high doses, metoclopramide works by blocking the messages to the part of the brain responsible for nausea and vomiting resulting from chemotherapy.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have stomach or intestinal problems such as bleeding, blockage, or perforation (hole) in the intestine. This medicine may worsen pain, bleeding, or intestinal damage.
  • If you have ever had seizures, have an abnormal EEG (brain waves) or are taking anti-seizure medicines. This drug may raise your risk of seizures.
  • If you have any medical conditions such as kidney disease, diabetes, or pheochromocytoma (adrenal tumor). It may require that your medicine dose or timing be changed.
  • If you have liver or heart disease. Metoclopramide may cause you to retain fluids and make these problems worse.
  • If you have an abnormal heart rhythm, heart block, heart failure, or any problem with the heart's electrical system, including long Q-T syndrome. Haloperidol can slow down the heart's electrical impulses and make these problems worse. It can also lower the blood pressure and deprive the heart of oxygen.
  • If you have high blood pressure. There is a chance of increasing blood pressure while on this medicine.
  • If you have ever had depression. This drug may cause or worsen depression.
  • If you have Parkinson's disease. Metoclopramide can worsen the symptoms.
  • If you take tranquilizers (sedatives) such as diazepam (Valium) or drink alcohol. Metoclopramide may increase the sleepiness linked to these substances.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. Although this drug does not cause birth defects in animals, tests in pregnant women have not been done.
  • If you are breast-feeding. This drug passes into breast milk in varying amounts, and may affect the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Substances that make you sleepy, such as alcohol, tranquilizers, muscle relaxers, opioid pain relievers, anesthetics, and sleeping pills will make you much sleepier and may cause harm when taken with metoclopramide.

Medicines with anti-cholinergic effects (such as many drugs used to treat muscle spasms, bladder spasms, motion sickness, stomach cramps, allergies, depression or the bronchial spasms of asthma) may stop metoclopramide from working as it should. Check with your doctor, nurse, or pharmacist about which drugs you take that may be anti-cholinergic.

Antidepressants known as monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may raise the risk of side effects and should not be taken within 2 weeks of taking metoclopramide.

Antipsychotics, neuroleptics, and other antidepressants increase your risk of serious side effects if taken while you are being treated with metoclopramide.

Metoclopramide can lessen or increase the amount of other drugs you can absorb. Talk with your doctor or pharmacist about how to reduce this risk.

Because metoclopramide speeds food through the intestine, diabetics may need to change their insulin dose to avoid low blood sugar.

Check with your doctor, nurse, or pharmacist about whether any of the medicines, vitamins, herbs, and supplements you are taking can cause problems with metoclopramide.

Interactions with foods

Avoid drinking alcohol while taking metoclopramide.

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Metoclopramide may be given before and after chemotherapy to prevent nausea and vomiting, and is often combined with other drugs such as dexamethasone and diphenhydramine. It is also sometimes given in low doses following cisplatin chemotherapy to prevent delayed nausea and vomiting. The drug is 3 different ways; as a pill you swallow, as a dissolving tablet that melts on the tongue, or as an available in injection in a vein. You should take pills or dissolving tablets by mouth 30 minutes before a meal and at bedtime.

If you are taking the dissolving tablet, be sure your hands are dry before you start. Take out one tablet and place on the tongue. It will usually dissolve in a minute or two, though some people may take longer.

Take this drug exactly as prescribed by your doctor. If you have any questions or are confused by the instructions, talk to your doctor or nurse.

Store the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Metoclopramide may make you feel sleepy. Do not drive, operate heavy machinery, or do anything requiring alertness when you are drowsy.

Be careful getting up, changing position, or walking. Start slowly and hold onto something or someone to hold you steady. Have a responsible adult with you until you know how the medicine will affect you and that you can take care of yourself.

Rarely, metoclopramide may cause unplanned movements called extrapyramidal effects. These include restlessness, tremors, sticking out the tongue, muscle tightness, and involuntary muscle contractions or spasms. Let your doctor or nurse know right away if this happens. These side effects can usually be stopped by other medicines such as diphenhydramine (Benadryl). In some cases, it may be necessary to stop the metoclopramide.

Call your doctor or nurse right away if you have restlessness, muscle stiffness, severe anxiety, slow jerky movements, tiredness, weakness, fever, confusion, trouble walking, irregular or fast heartbeat, or yellow eyes or skin.

This drug can cause a rare problem called neuroleptic malignant syndrome, with symptoms like fever, tight muscles, tremors, sweating, constipation, and confusion. This syndrome can become life-threatening if not treated right away. If you have symptoms like these, call your doctor without delay.

At higher doses over long periods, metoclopramide can cause a movement problem called tardive dyskinesia. This is most likely to happen in older people who are taking other medicines as well. If you notice repeated instances of puffing out of cheeks, puckering of the mouth, grimacing, chewing movements, smacking your lips, or blinking that you can't control, call your doctor or nurse right away. Stopping the drug quickly may allow these problems to go away.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • feeling sedated (tranquil or calm)
  • sleepiness
  • diarrhea
  • dry mouth

Less common

  • restlessness
  • tiredness (fatigue)
  • trouble sleeping
  • dizziness

Rare

  • Rash
  • allergic reaction with hives (skin welts), swelling of the face, mouth, tongue or throat, trouble breathing or swallowing, dizziness
  • low blood pressure, with dizziness or faintness*
  • unplanned (involuntary) movements, which may not go away*
  • neck spasms (cramps) and tightness in the throat, trouble swallowing
  • serious depression, sometimes with suicidal thoughts or actions
  • sudden rise in blood pressure
  • swelling or retaining fluid
  • high body temperature with confusion and other symptoms*
  • abnormal heart rhythm

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 10/14/2009
Last Revised: 10/14/2009