Prescribing information:
- By mouth, intramuscular injection, or intravenous injection (over 1-2 minutes), 10 mg tds.
- High-dose metoclopramide can be used with cytotoxic chemotherapy; seek specialist advice.
Metoclopramide is metabolized by the liver. Reduce the dose in hepatic insufficiency.
- Antiemetic drugs are rarely needed for vomiting associated with pregnancy. If severe seek specialist advice. Metoclopramide is an option in such cases.
- Do not use metoclopramide in patients with gastrointestinal obstruction or haemorrhage; the actions on the stomach may be dangerous.
- Do not use metoclopramide in patients with Parkinsonian symptoms; the antidopaminergic actions can worsen these.
- Do not give metoclopramide to patients with phaeochromocytoma; it can precipitate a hypertensive crisis.
- The use of metoclopramide in patients under 20 years old is specialized
- Nausea and vomiting are symptoms, not diagnoses. Always consider the underlying cause. Long-term treatment should be of the cause, rather than with antiemetic drugs.
- Like the treatment of pain, the treatment of nausea and vomiting should be based on avoidance and prophylaxis, rather than waiting for symptoms to occur before tackling them.
Metoclopramide is used widely but is especially useful:
- For nausea owing to gastrointestinal, biliary, and liver disease; however, it should not be used if there is gastrointestinal obstruction.
- In high dosages for emesis associated with chemotherapy, but it has largely been replaced by the 5HT3 receptor antagonists for this indication.
- Consider the following factors:
- Identify patients who are at high risk of postoperative nausea and vomiting and give them treatment early. A dose of 10 mg alone is often inadequate for postoperative nausea and vomiting.
- Treat pain, as this is often a contributory factor.
- Refer to the teaching point in 5HT3 receptor antagonists (p. 73) for information on the treatment of nausea and vomiting due to chemotherapy.
- Metoclopramide is unlikely to be effective for motion sickness; this is mediated through the vestibular system.
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