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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%