metoclopramide
Last reviewed 01/2018
Metoclopramide is an anti-emetic with a wide spectrum of activity that closely resembles that of phenothiazines. However, in addition to its central effect, it has a peripheral action on the gut. This means that it is superior to the phenothiazines in emesis that is associated with gastroduodenal, biliary or hepatic disease.
The European Medicines Agency's Committee on Medicinal Products for Human Use has reviewed the benefits and risks of the antiemetic metoclopramide. The review was done at the request of the French medicines regulatory agency (ANSM), following concerns over side effects and efficacy. The review confirmed the well known risks of neurological effects such as short-term extrapyramidal disorders and tardive dyskinesia. The conclusion of the review was that these risks outweigh the benefits in long-term or high-dose treatment.
- Advice for healthcare professionals:
- Indications and use in adults and children:
- in adults, metoclopramide remains indicated for:
- prevention of postoperative nausea and vomiting; radiotherapy-induced
nausea and vomiting; delayed (but not acute) chemotherapy-induced
nausea and vomiting; and symptomatic treatment of nausea and vomiting,
including that associated with acute migraine (where it may also
be used to improve absorption of oral analgesics)
- prevention of postoperative nausea and vomiting; radiotherapy-induced
nausea and vomiting; delayed (but not acute) chemotherapy-induced
nausea and vomiting; and symptomatic treatment of nausea and vomiting,
including that associated with acute migraine (where it may also
be used to improve absorption of oral analgesics)
- in children, age 1-18 years, metoclopramide should only be used
as a second-line option for prevention of delayed chemotherapy-induced
nausea and vomiting, and for treatment of established postoperative
nausea and vomiting
- use of metoclopramide is contraindicated in children younger
than 1 year
- metoclopramide should only be prescribed for short-term use (up
to 5 days)
- in adults, metoclopramide remains indicated for:
- dosing:
- for adults, the maximum dose in 24 hours is 30 mg (or 0.5 mg per
kg bodyweight). The usual dose is 10 mg up to three times a day In
children age 1 year or older, the recommended dose is 0.1-0.15 mg
per kg bodyweight, repeated up to three times a day. The maximum dose
in 24 hours is 0.5 mg per kg bodyweight
- for adults, the maximum dose in 24 hours is 30 mg (or 0.5 mg per
kg bodyweight). The usual dose is 10 mg up to three times a day In
children age 1 year or older, the recommended dose is 0.1-0.15 mg
per kg bodyweight, repeated up to three times a day. The maximum dose
in 24 hours is 0.5 mg per kg bodyweight
- administration:
- intravenous doses should be administered as a slow bolus over at least 3 minutes to reduce the risk of adverse effects
- oral liquid formulations should be given via an appropriately designed, graduated oral syringe to ensure dose accuracy in children
- Indications and use in adults and children:
The summary of product characteristics should be consulted before prescribing this drug.
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