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Reglan
metoclopramide
Black Box Warnings .
Tardive Dyskinesia
contraindicated in patients with tardive dyskinesia history; metoclopramide can cause tardive dyskinesia, a serious, potentially irreversible movement disorder; risk incr. with tx duration and total cumulative dosage; use shortest effective tx duration and periodically reassess need for tx; D/C immediately if patient develops tardive dyskinesia signs/symptoms; 12wk max tx duration for symptomatic, documented GERD; avoid >12wk tx for gastroparesis (if longer-term use unavoidable, then routinely monitor for tardive dyskinesia signs/symptoms)
Adult Dosing .
Dosage forms: TAB: 5 mg, 10 mg
Dosage Form Details
- [ODT, SOLUTION, INJ forms discontinued in US for this brand; see generic]
gastroparesis
- [PO route]
- Dose: 5-10 mg PO tid-qid; Max: 40 mg/day; 12wk; Info: start 5 mg PO qid in elderly patients; give 5 mg PO qid, max 20 mg/day in CYP2D6 poor metabolizers; give 30min before meals and at bedtime
- [IM/IV route]
- Dose: 10 mg IM/IV qid for up to 10 days; Max: 40 mg/day; 12 wk; Info: use lower doses in elderly patients; switch to PO when possible
GERD
- [10-15 mg PO qid x4-12wk]
- Max: 60 mg/day; 12wk; Alt: give up to 20 mg PO x1 prn before GERD-provoking situation; Info: for patients with concomitant gastroparesis; start 5 mg PO qid in elderly patients; give 5 mg PO qid or 10 mg PO tid, max 30 mg/day in CYP2D6 poor metabolizers; give 30min before meals and at bedtime
nausea/vomiting prevention, postop
- [10-20 mg IM/IV x1]
- Start: dose near end of procedure
small bowel intubation, post-pyloric placement
- [10 mg IV x1 dose]
barium transit time acceleration, GI diagnostic studies
- [10 mg IV x1 dose]
nausea/vomiting prevention, chemo-related
- [highly-emetogenic chemo]
- Dose: 2 mg/kg/dose IV q2h x3 doses, then 2 mg/kg/dose IV q3h x3 doses; Start: 30min before chemo; Info: may give 1 mg/kg/dose IV q2h x3 doses, then 1 mg/kg/dose IV q3h x3 doses for less emetogenic chemo
- [low-emetogenic parenteral chemo (off-label)]
- Dose: 10-20 mg PO/IV x1; Start: 30min before chemo; Info: may repeat 10-20 mg PO/IV qd for multi-day chemo; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool
- [minimal- to low-emetogenic oral chemo (off-label)]
- Dose: 10-20 mg PO x1 on day 1, then 10-20 mg PO q6h prn; Start: 30min before chemo; Info: search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool
breakthrough nausea/vomiting, chemo-related (off-label)
- [10-20 mg PO/IV q4-6h]
- Info: search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool
nausea/vomiting, migraine-associated (off-label)
- [10-20 mg IV x1]
- Alt: 5-10 mg PO/IM/IV q6-8h prn; Max: 45 mg/day
renal dosing
- [gastroparesis, PO route]
- CrCl <60: 5 mg qid, max 20 mg/day; ESRD: 5 mg bid, max 10 mg/day
- HD: 5 mg bid, max 10 mg/day; no supplement after dialysis; PD: 5 mg bid, max 10 mg/day; no supplement
- [GERD]
- CrCl <60: 5 mg qid or 10 mg tid, max 30 mg/day; ESRD: 5 mg qid or 10 mg bid, max 20 mg/day
- HD: 5 mg qid or 10 mg bid, max 20 mg/day; no supplement after dialysis; PD: 5 mg qid or 10 mg bid, max 20 mg/day; no supplement
- [all other indications]
- CrCl <60: decr. usual dose by 50%; ESRD: decr. usual dose by 75%
- HD: decr. usual dose by 75%; no supplement after dialysis; PD: decr. usual dose by 75%; no supplement
hepatic dosing
- [gastroparesis, PO route]
- Child-Pugh Class B or C: 5 mg qid, max 20 mg/day
- [GERD]
- Child-Pugh Class B or C: 5 mg qid or 10 mg tid, max 30 mg/day
- [all other indications]
- Child-Pugh Class B or C: decr. usual dose by 50%
Peds Dosing .
- Dosage forms: TAB: 5 mg, 10 mg
Dosage Form Details
- [ODT, SOLUTION, INJ forms discontinued in US for this brand; see generic]
small bowel intubation, post-pyloric placement
- [<6 yo]
- Dose: 0.1 mg/kg/dose IV x1
- [6-14 yo]
- Dose: 2.5-5 mg IV x1
- [>14 yo]
- Dose: 10 mg IV x1
GERD (off-label)
- [0.1-0.2 mg/kg/dose PO qid]
- Max: 10 mg/dose, 0.8 mg/kg/24h; 12wk; Info: not recommended for infants and children per NASPGHAN/ESPGHAN guidelines; give 30min before meals and at bedtime
nausea/vomiting prevention, chemo-related (off-label)
- [1-2 mg/kg/dose IV q2-4h]
- Info: give 30min before chemo; pretreat with diphenhydramine to decr. EPS; not 1st-line agent
nausea/vomiting prevention, postop (off-label)
- [0.1-0.2 mg/kg/dose IV x1]
- Start: dose near end of procedure; Max: 10 mg/dose
nausea/vomiting, migraine-associated (off-label)
- [2 yo and older]
- Dose: 0.2 mg/kg/dose IV x1; Max: 10 mg/dose
renal dosing
- [adjust dose amount]
- CrCl <60: decr. usual dose by 50%; ESRD: decr. usual dose by 75%
- HD: decr. usual dose by 75%; no supplement after dialysis; PD: decr. usual dose by 75%; no supplement
hepatic dosing
- [adjust dose amount]
- Child-Pugh Class B or C: decr. usual dose by 50%
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- tardive dyskinesia history
- dystonic reaction history, metoclopramide-associated
- GI bleeding
- GI perforation
- GI obstruction
- pheochromocytoma
- paraganglioma, catecholamine-releasing
- HTN
- seizure disorder
- depression
- Parkinson disease
- caution: hypersensitivity to tartrazine (some generic forms)
- caution: CNS depressant use, concurrent
- caution: alcohol use, concurrent
- caution: CYP2D6 poor metabolizers
- caution: neonates
- caution: peds patients
- caution: elderly patients
- caution: CrCl <60
- caution: hepatic impairment, Child-Pugh Class B-C
- caution: cirrhosis
- caution: CHF
- caution: diabetes mellitus
- caution: NADH methemoglobin reductase deficiency
Drug Interactions .
Overview
metoclopramide
dopamine-2 antagonist; prokinetic
- CYP2D6 substrate
- CYP3A4 substrate
- affected by altered gastrointestinal motility
- CNS depression
- dopamine antagonist
- extrapyramidal effects
- hyperprolactinemic effects
- hypertensive effects
- increases gastrointestinal motility
- lowers seizure threshold
- methemoglobinemia
- serotonergic effects
Contraindicated
- lidocaine topical
- prilocaine topical
Avoid/Use Alternative
- 5-HTP
- aldesleukin
- alfentanil
- allopurinol
- almotriptan
- alprazolam
- amantadine
- amifampridine
- amitriptyline
- amoxapine
- amphetamine
- apomorphine
- apraclonidine ophthalmic
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- atovaquone
- baclofen
- baclofen intrathecal
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- buprenorphine
- bupropion
- buspirone
- butalbital
- butorphanol
- cabergoline
- cannabidiol
- cannabis
- carbamazepine
- carbinoxamine
- cariprazine
- carisoprodol
- cenobamate
- cetirizine
- chamomile, German
- chasteberry
- chlophedianol
- chlorcyclizine
- chlordiazepoxide
- chloroquine
- chlorpheniramine
- chlorpromazine
- chlorzoxazone
- citalopram
- clemastine
- clobazam
- clomipramine
- clonazepam
- clonidine
- clorazepate
- clozapine
- codeine
- cyclobenzaprine
- cyproheptadine
- dacomitinib
- dantrolene
- daridorexant
- darifenacin
- desflurane
- desipramine
- desvenlafaxine
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dexmedetomidine
- dexmedetomidine injection
- dextroamphetamine
- diazepam
- dichlorphenamide
- difelikefalin
- difenoxin
- dihydrocodeine
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- domperidone
- doxepin
- doxepin topical
- doxylamine
- dronabinol
- droperidol
- duloxetine
- efavirenz
- eletriptan
- elinzanetant
- entacapone
- entrectinib
- epinephrine inhaled
- escitalopram
- esketamine
- eslicarbazepine acetate
- estazolam
- eszopiclone
- ethanol (alcoholic beverage)
- ethanol (in some formulations)
- ethanol injection
- ethosuximide
- etomidate
- felbamate
- fenfluramine
- fentanyl
- fesoterodine
- flibanserin
- fluoxetine
- fluphenazine
- flurazepam
- fluvoxamine
- foslevodopa
- fosphenytoin
- frovatriptan
- furosemide
- gabapentin
- gabapentin enacarbil
- galantamine
- ganaxolone
- gepirone
- glofitamab
- glycopyrrolate
- granisetron
- guanfacine
- haloperidol
- hydrocodone
- hydromorphone
- hydroxyzine
- hyoscyamine
- ifosfamide
- iloperidone
- imipramine
- iohexol
- isocarboxazid
- isoflurane
- isoniazid
- kava
- ketamine
- kratom
- lacosamide
- lamotrigine
- lemborexant
- levetiracetam
- levocetirizine
- levodopa
- levomilnacipran
- levorphanol
- linezolid
- linvoseltamab
- lisdexamfetamine
- lithium
- lofexidine
- lorazepam
- loxapine
- lumateperone
- lurasidone
- mavorixafor
- meclizine
- melatonin
- meperidine
- meprobamate
- metaxalone
- methadone
- methamphetamine
- methocarbamol
- methohexital
- methsuximide
- methyldopa
- methylene blue oral
- metyrapone
- metyrosine
- midazolam
- midodrine
- milnacipran
- milsaperidone
- mirtazapine
- mitotane
- molindone
- morphine
- mosunetuzumab
- mycophenolate mofetil
- nalbuphine
- naltrexone
- naratriptan
- nefazodone
- nelarabine
- nortriptyline
- olanzapine
- oliceridine
- ondansetron
- opicapone
- opium
- orphenadrine
- oxazepam
- oxcarbazepine
- oxybate
- oxybutynin
- oxycodone
- oxymorphone
- paliperidone
- paroxetine
- passion flower
- pentazocine
- pentobarbital
- perampanel
- perphenazine
- phenelzine
- pheniramine
- phenobarbital
- phenytoin
- pimozide
- pramipexole
- pramlintide
- pregabalin
- primaquine
- primidone
- procarbazine
- prochlorperazine
- promethazine
- propofol
- protriptyline
- pyrilamine
- quazepam
- quetiapine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- ramelteon
- rasagiline
- remifentanil
- remimazolam
- repotrectinib
- risperidone
- rivastigmine
- rizatriptan
- ropeginterferon alfa-2b
- ropinirole
- rotigotine transdermal
- rufinamide
- safinamide
- scopolamine
- selegiline
- selegiline transdermal
- selinexor
- sertraline
- sevoflurane
- solifenacin
- solriamfetol
- stiripentol
- sufentanil
- sumatriptan
- suvorexant
- tapentadol
- tasimelteon
- tedizolid
- temazepam
- terbinafine
- tetrabenazine
- thalidomide
- thioridazine
- thiotepa
- thiothixene
- tiagabine
- tizanidine
- tolcapone
- tolterodine
- topiramate
- tradipitant
- tramadol
- tranylcypromine
- trazodone
- triazolam
- trifluoperazine
- trihexyphenidyl
- trimethobenzamide
- trimipramine
- triprolidine
- triptorelin
- trospium
- valbenazine
- valerian
- valproic acid
- venlafaxine
- vigabatrin
- vilazodone
- viloxazine
- vortioxetine
- yohimbe
- zaleplon
- ziconotide
- ziprasidone
- zolmitriptan
- zolpidem
- zonisamide
- zuranolone
Monitor/Modify Tx
- abiraterone acetate
- acebutolol
- albuterol
- albuterol inhaled
- aliskiren
- amiloride
- amlodipine
- angiotensin II
- aprocitentan
- arformoterol inhaled
- armodafinil
- asciminib
- atenolol
- atogepant
- atomoxetine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- benzphetamine
- betamethasone
- betaxolol
- bevacizumab
- bismuth subsalicylate
- bisoprolol
- black cohosh
- brigatinib
- budesonide
- bumetanide
- cabozantinib
- caffeine
- caffeine citrate
- candesartan cilexetil
- captopril
- carfilzomib
- carvedilol
- celecoxib
- chlorothiazide
- chlorthalidone
- clevidipine
- cocaine
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- danazol
- darbepoetin alfa
- deflazacort
- desmopressin
- dexamethasone
- dexmethylphenidate
- dextromethorphan
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- digoxin
- dihydroergotamine
- diltiazem
- dobutamine
- dopamine
- doxapram
- doxazosin
- droxidopa
- enalapril
- enalaprilat
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- felodipine
- fenoldopam
- fenoprofen
- fingolimod
- fludrocortisone
- flurbiprofen
- flutamide
- formoterol inhaled
- fosinopril
- fostamatinib
- fremanezumab
- fruquintinib
- galcanezumab
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- ibrutinib
- ibuprofen
- indapamide
- indomethacin
- insulin
- iopamidol
- irbesartan
- isradipine
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- leflunomide
- lenvatinib
- levalbuterol inhaled
- licorice
- lisinopril
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methoxy polyethylene glycol-epoetin beta
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metolazone
- metoprolol
- minoxidil
- mirabegron
- modafinil
- moexipril
- nabumetone
- nadolol
- naproxen
- naxitamab
- nebivolol
- nicardipine
- nifedipine
- nimodipine
- niraparib
- nisoldipine
- nitric oxide
- nitrite
- norepinephrine
- obinutuzumab
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- palonosetron
- pazopanib
- perindopril
- pexidartinib
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- piroxicam
- ponatinib
- ponesimod
- posaconazole
- pralsetinib
- prazosin
- prednisolone
- prednisone
- propranolol
- pseudoephedrine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- rimegepant
- ripretinib
- salmeterol inhaled
- salsalate
- SAMe
- selpercatinib
- siponimod
- sirolimus
- sorafenib
- spironolactone
- St. John's wort
- succinylcholine
- sulindac
- sunitinib
- tacrolimus
- tagraxofusp
- telmisartan
- terazosin
- terbutaline
- teriflunomide
- testosterone
- timolol
- tivozanib
- tolmetin
- torsemide
- trametinib
- trandolapril
- triamcinolone
- triamterene
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vandetanib
- vasopressin
- verapamil
- vilanterol inhaled
- voclosporin
- zavegepant
- ziv-aflibercept
Caution Advised
- acetazolamide
- aclidinium inhaled
- apalutamide
- articaine
- atropine
- belladonna alkaloids
- benzocaine topical
- benztropine
- bosentan
- bremelanotide
- bupivacaine
- bupivacaine liposomal
- busulfan
- butamben
- chlorambucil
- chloroprocaine
- clidinium
- dabrafenib
- dapsone
- dapsone topical
- dicyclomine
- disopyramide
- dulaglutide
- encorafenib
- enzalutamide
- etravirine
- exenatide
- fexinidazole
- flavoxate
- fosfomycin oral
- glycopyrrolate inhaled
- glycopyrronium topical
- goserelin
- histrelin
- homatropine
- hydroxychloroquine
- ipratropium inhaled
- isosorbide dinitrate
- isosorbide mononitrate
- ivosidenib
- leuprolide
- lidocaine
- liraglutide
- lixisenatide
- loperamide
- lopinavir/ritonavir
- magnesium citrate
- mavacamten
- mepivacaine
- methscopolamine
- mexiletine
- mitapivat
- nafcillin
- nitrofurantoin
- nitroglycerin
- nitroprusside
- pacritinib
- polyethylene glycol
- polyethylene glycol/electrolytes
- procaine
- rasburicase
- resorcinol topical
- revefenacin inhaled
- rifabutin
- rifampin
- rifapentine
- ropivacaine
- sodium picosulfate
- sofpironium topical
- sotorasib
- sulfadiazine
- sulfamethoxazole
- sulfasalazine
- sulfate bowel prep
- tafenoquine
- tetracaine
- tiotropium inhaled
- tirzepatide
- treosulfan
- umeclidinium inhaled
Adverse Reactions .
Serious Reactions
- extrapyramidal symptoms
- dystonia, acute
- parkinsonism
- tardive dyskinesia
- neuroleptic malignant syndrome
- seizures
- depression
- suicidality
- hallucinations
- leukopenia
- neutropenia
- agranulocytosis
- methemoglobinemia
- CHF, acute
- AV block
- SVT
- HTN, severe
- angioedema
- hepatotoxicity
- withdrawal symptoms if abrupt D/C
Common Reactions
- drowsiness
- restlessness
- fatigue
- anxiety
- insomnia
- headache
- confusion
- dizziness
- depression
- extrapyramidal symptoms
- galactorrhea
- amenorrhea
- gynecomastia
- hyperprolactinemia
- impotence
- hyperaldosteronism
- fluid retention
- hypotension
- HTN
- bradycardia
- nausea
- diarrhea
- urinary frequency
- incontinence
- rash
- urticaria
- visual disturbance
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; signs/symptoms of tardive dyskinesia routinely if >12wk tx
Look/Sound-Alike Drug Names
Reglan confused with: Megace; Regitine; Regonol; Relafen; Renagel; Requip; Robaxin; Robitussin; Zofran
metoclopramide confused with: methocarbamol; methylPREDNISolone sodium succinate; metOLazone; metoprolol; metoprolol tartrate; metroNIDAZOLE; trimethobenzamide
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; no known risk of fetal harm based on human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm or adverse effects on milk production based on human data
Pharmacology .
Metabolism: for metoclopramide: liver minimally; CYP450: 2D6 substrate
Excretion: for metoclopramide: urine 85% (20% unchanged), bile/feces 5%; Half-life: 5-6h
Subclass: Antiemetics, Dopamine Antagonists ; Diagnostic Agents, Gastrointestinal ; Headache/Migraine ; Prokinetics
Mechanism of Action
for metoclopramide: exact mechanism of action unknown; sensitizes tissues to acetylcholine, stimulating upper GI tract motility; antagonizes central and peripheral dopamine receptors, producing antiemetic effects
Formulary .
No Formulary Selected
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