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Metoclopramide: Drug information

Metoclopramide: Drug information
(For additional information see "Metoclopramide: Patient drug information" and see "Metoclopramide: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Tardive dyskinesia:

Metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. There is no known treatment for tardive dyskinesia. The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose. Discontinue metoclopramide in patients who develop signs or symptoms of tardive dyskinesia. In some patients, symptoms lessen or resolve after metoclopramide is stopped. Avoid treatment with metoclopramide for longer than 12 weeks because of the increased risk of developing tardive dyskinesia with longer-term use.

Brand Names: US
  • Gimoti;
  • Reglan
Brand Names: Canada
  • MAR-Metoclopramide;
  • Metonia;
  • PMS-Metoclopramide;
  • PMS-Metoclopramide HCl
Pharmacologic Category
  • Antiemetic;
  • Dopamine Antagonist;
  • Gastrointestinal Agent, Prokinetic;
  • Serotonin 5-HT4 Receptor Agonist
Dosing: Adult

Dosage guidance:

Safety: To decrease the risk of tardive dyskinesia (TD), do not use continuously for ≥12 weeks. Discontinue immediately if the diagnosis of TD is made; consider the use of alternative agents.

Dosing: In Canada, product information limits the total daily dose to 0.5 mg/kg except when used for prophylaxis of delayed emesis associated with cisplatin chemotherapy.

Aspiration prophylaxis in patients undergoing anesthesia

Aspiration prophylaxis in patients undergoing anesthesia (off-label use):

Note: May be considered in patients at high risk for aspiration (Ref):

IV: 10 mg administered over 1 to 2 minutes as a single dose ~30 to 60 minutes prior to induction of anesthesia; usually given with nonparticulate antacid(s) (eg, oral sodium citrate, citric acid) and/or an H2 receptor antagonist (Ref).

Bowel obstruction, malignant inoperable

Bowel obstruction (partial), malignant inoperable (off-label use):

Note: Do not use in patients with confirmed or suspected complete mechanical obstruction (Ref). Often given in combination regimen (eg, with an antisecretory agent, corticosteroid, and/or anticholinergic) (Ref). Avoid metoclopramide use if colic or abdominal pain are present (Ref).

Oral, IV, SUBQ: 10 mg every 4 to 6 hours (Ref); if insufficient relief with intermittent dosing, may switch to an IV or SUBQ continuous infusion.

Continuous IV or SUBQ infusion: Initial: 1.25 to 1.75 mg/hour; titrate as needed and tolerated up to 5 mg/hour (Ref).

Chemotherapy-induced nausea and vomiting, prevention

Chemotherapy-induced nausea and vomiting, prevention (alternative agent):

Note: Not for routine use; may be considered in select patients (eg, patients refractory to first-line agents or patients with a history of nausea/vomiting following low-emetic-risk regimens). Other agents are safer and more effective (Ref).

Low-emetic-risk IV chemotherapy:

Oral: Dosing regimen based on expert opinion: 10 mg before chemotherapy or 10 mg every 6 hours as needed (Ref).

Prophylaxis of delayed emesis (high-emetic-risk chemotherapy regimen) (alternative agent) (off-label use):

Note: Routine use is not recommended for prophylaxis of delayed emesis (alternative agents recommended); however, potential alternative to neurokinin 1 (NK1) receptor antagonist (eg, aprepitant, fosaprepitant) in patients receiving cisplatin.

Oral: 10 to 20 mg 4 times daily on postchemotherapy days 2 through 4; given in combination with dexamethasone (Ref).

Dyspepsia, functional

Dyspepsia, functional (refractory) (off-label use):

Note: For patients unresponsive to first-line therapies (eg, proton pump inhibitors, Helicobacter pylori eradication, and/or tricyclic antidepressants) (Ref); some experts recommend limiting duration of metoclopramide therapy to 4 weeks (Ref):

Oral: 5 to 10 mg 3 to 4 times daily administered prior to meals and at bedtime (Ref). A lower dose of 2 mg 3 times daily (using oral liquid formulation) may provide sufficient response (Ref).

Gastroparesis, diabetic and nondiabetic

Gastroparesis, diabetic (labeled use) and nondiabetic (off-label use):

Note: For patients who have had insufficient response to appropriate initial interventions (eg, dietary therapy, discontinuing drugs that impair GI motility, improved glycemic control in diabetic gastroparesis) (Ref). With diabetic gastroparesis, some experts suggest limiting use to severe refractory cases (Ref). Initiating treatment with an oral liquid formulation is preferred and may improve absorption.

Nasal: One spray (15 mg) in one nostril 4 times daily (30 minutes prior to each meal and at bedtime) for 2 to 8 weeks depending on symptomatic response; maximum: 4 sprays (60 mg)/day.

Missed/incomplete doses: If a dose is missed or it is uncertain whether the spray entered the nose, do not repeat or make up dose; take dose at the next scheduled time.

Oral (preferred), IM, IV, SUBQ: 5 to 10 mg 2 to 3 times daily administered prior to meals. Titrate to the lowest effective dose; maximum: 40 mg/day in 4 divided doses (Ref). If parenteral administration is indicated, some experts do not exceed 30 mg/day in 3 divided doses (Ref). In gastroparesis associated with anorexia nervosa, a lower oral dose of 2.5 mg administered prior to each meal and at bedtime may provide sufficient symptom relief according to some experts (Ref).

Duration: In chronic therapy, limit course to ≤12 weeks. Consider a “drug holiday” or dose reduction (eg, 5 mg twice daily before two main meals of the day) for ~2 weeks whenever clinically feasible or at least every 12 weeks (whichever is shorter) to evaluate efficacy and necessity of continued treatment (Ref).

Hiccups

Hiccups (off-label use):

Note: Limited data available. Treatment generally continues for up to 5 to 10 days. May discontinue treatment the day after hiccups subside; if hiccups recur, longer treatment duration may be needed (eg, in palliative care) (Ref).

IV: 5 to 10 mg every 8 hours (Ref).

Oral: 10 mg every 6 to 8 hours (Ref).

Medication-overuse headache or intractable migraine

Medication-overuse headache or intractable migraine (status migrainosus) (adjunctive agent) (off-label use):

Note: Use as part of an appropriate combination regimen or as adjunctive therapy for prevention of nausea and vomiting in patients receiving dihydroergotamine (Ref). Premedication with diphenhydramine is suggested to prevent akathisia and other acute dystonic reactions (Ref). Practice varies by institutional protocol; example regimen below.

IV: Initial: 10 mg administered immediately prior to dihydroergotamine; repeat as needed every 8 hours, either prior to each intermittent dihydroergotamine dose or during continuous IV administration of dihydroergotamine (Ref). Doses of metoclopramide up to 20 mg have been used in patients experiencing severe nausea (Ref).

Migraine, severe, acute treatment

Migraine, severe, acute treatment (emergency setting) (off-label use):

Note: Use as monotherapy or as part of an appropriate combination regimen (Ref). IV administration may be more efficacious (Ref). Premedication with diphenhydramine is suggested to prevent akathisia and other acute dystonic reactions (Ref).

IV (preferred), IM, Oral, SUBQ: 10 mg as a single dose; for migraine with severe nausea and vomiting, some experts increase the dose to 20 mg (Ref).

Nausea and/or vomiting

Nausea and/or vomiting:

Undifferentiated or due to a variety of medical conditions associated with acute self-limiting nausea/vomiting (alternative agent) (off-label use): Limited data available:

IV: 10 mg or 20 mg as a single dose (Ref); avoid rapid IV administration of doses >10 mg.

Oral: 10 mg as a single dose; may repeat after 4 to 6 hours if needed.

Advanced cancer-associated (off-label use):

Note: Limited data available; dosing recommendations based primarily on expert opinion:

Empiric therapy in patients without an identifiable etiology:

Oral, IV, SUBQ: 10 mg every 6 hours (Ref).

Malignancy-associated gastroparesis:

Oral, IV, SUBQ: 5 to 10 mg every 6 hours or 3 to 4 times daily before meals and at night (Ref).

Palliative care setting:

Oral, IV, SUBQ: Initial: 5 to 10 mg every 4 to 6 hours (Ref). For severe symptoms, some experts titrate up to 100 mg/day (in divided doses) if needed (Ref). If insufficient relief with intermittent dosing, may switch to an IV or SUBQ continuous infusion.

Continuous IV or SUBQ infusion: Initial: 1.25 to 1.75 mg/hour; titrate as needed and tolerated up to 5 mg/hour (Ref).

Nasal: One spray (15 mg) in one nostril 4 times daily (30 minutes prior to each meal and at bedtime) for 2 to 8 weeks depending on symptomatic response; maximum: 4 sprays (60 mg)/day (Ref).

Missed/incomplete doses: If a dose is missed or it is uncertain whether the spray entered the nose, do not repeat or make up dose; take dose at the next scheduled time.

Pregnancy-associated, severe or refractory (off-label use):

Note: May be considered as add-on or alternative therapy for nausea and vomiting when symptoms persist following initial pharmacologic therapy and IV hydration if hypovolemic (Ref).

Oral, IV, IM: 5 to 10 mg every 6 to 8 hours, added to current treatment regimen or as alternative therapy; if feasible, give 30 minutes before meals and bedtime (Ref).

Vertigo-associated (alternative agent) (off-label use):

Oral, IV: 5 to 10 mg every 6 hours as needed (Ref).

Postoperative nausea and vomiting, prophylaxis

Postoperative nausea and vomiting, prophylaxis (alternative agent):

Note: Available data to support use in this condition are limited (Ref). May use when dopamine antagonists are indicated but other preferred agents (eg, droperidol) cannot be used (Ref).

IM, IV (off-label route): 10 mg administered near the end of surgery (Ref). Note: Higher doses (eg, 20 to 50 mg) may be more efficacious; however, some experts avoid use of these doses due to increased risk of adverse reactions (eg, hypotension, tachycardia, extrapyramidal effects) (Ref).

Radiation therapy–induced nausea and vomiting

Radiation therapy–induced nausea and vomiting (rescue therapy) (alternative agent) (off-label use):

Low-emetic-risk radiation therapy (head and neck, thorax, or pelvis):

Oral, IV: 5 to 20 mg if needed after each radiation treatment and repeated every 6 to 8 hours; depending on symptom severity and remaining duration of radiation therapy, patients can receive subsequent rescue therapy as needed or begin prophylactic therapy (Ref).

Minimal-emetic-risk radiation therapy (extremities, breast):

Oral, IV: 5 to 20 mg if needed after each radiation treatment (Ref).

Note: Avoid rapid IV administration of doses >10 mg.

Small bowel intubation, postpyloric feeding tube placement

Small bowel intubation, postpyloric feeding tube placement:

Note: Available data to support use in this condition are limited (Ref).

IV: 10 to 20 mg as a single dose administered 10 to 15 minutes prior to tube insertion (Ref).

Tension-type headache, acute

Tension-type headache, acute (emergency setting) (alternative agent) (off-label use):

Note: Limited data available.

IV: 10 mg as a single dose (Ref) or 20 mg as a single dose; premedicate with IV diphenhydramine to prevent akathisia and other acute dystonic reactions (Ref). Note: Avoid rapid IV administration of metoclopramide doses >10 mg.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Injection, Oral:

Altered kidney function (Ref):

CrCl >60 mL/minute: No dosage adjustment necessary.

CrCl >10 to 60 mL/minute: Administer ~50% of usual total daily dose.

CrCl ≤10 mL/minute: Administer ~33% (or less) of usual total daily dose.

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzed (Ref): Administer ~33% (or less) of usual total daily dose (Ref).

Peritoneal Dialysis: Not significantly dialyzed (Ref): Administer ~33% (or less) of usual total daily dose (Ref).

CRRT : Not likely to be substantially removed due to large volume of distribution: Administer ~50% of usual total daily dose (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Not likely to be substantially removed due to large volume of distribution: Administer ~50% of usual total daily dose (Ref).

Nasal:

CrCl >60 mL/minute: No dosage adjustment necessary.

CrCl ≤60 mL/minute: Use not recommended; dose cannot be easily adjusted.

Dosing: Hepatic Impairment: Adult

IV: There are no dosage adjustments provided in the manufacturer's labeling; however, metoclopramide has been used safely in patients with advanced liver disease with normal renal function.

Nasal:

Mild impairment (Child-Pugh class A): No dosage adjustment necessary.

Moderate or severe impairment (Child-Pugh class B or C): Use not recommended; dose cannot be easily adjusted.

Oral:

Diabetic gastroparesis:

Mild impairment (Child-Pugh class A): No dosage adjustment necessary.

Moderate or severe impairment (Child-Pugh class B or C): 5 mg 4 times daily (maximum: 20 mg/day).

Dosing: Older Adult

Note: Avoid use, except for gastroparesis. Limit duration to ≤12 weeks, with rare exceptions (Ref).

Nasal: Not recommended as initial therapy. Patients stable on 10 mg 4 times daily of other formulations may be switched to 1 spray (15 mg) 4 times daily for 2 to 8 weeks depending on symptomatic response. Refer to adult dosing.

Oral/Injection: Initial: Dose at the lower end of the recommended range (may require only 5 mg/dose) and use the lowest effective dose. Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Metoclopramide: Pediatric drug information")

Chemotherapy-induced nausea and vomiting, prevention, alternative agent

Chemotherapy-induced nausea and vomiting (CINV), prevention, alternative agent: Limited data available; optimal dose not established; efficacy results variable:

Note: Guidelines do not recommend metoclopramide for prevention of CINV due to lack of proven efficacy and safety (Ref). Metoclopramide may be considered for breakthrough CINV in patients receiving highly emetogenic chemotherapy who cannot receive olanzapine and for the prevention of refractory CINV after assessment of risk versus benefit (Ref). Doses required to prevent CINV are high and should not be used first-line due to increased risk of extrapyramidal symptoms (acute dystonic reactions); concurrent administration of diphenhydramine or benztropine is recommended to prevent drug-induced adverse effects (Ref).

Children and Adolescents: IV: 0.5 to 2 mg/kg/dose prior to chemotherapy; may repeat up to 4 times daily; usual adult dose: 10 mg/dose (Ref); although more frequent dosing has been described (every 2 to 4 hours), adverse events were more common (Ref). To limit the risk of extrapyramidal symptoms, more restrictive dosing of 0.1 to 0.15 mg/kg/dose every 6 hours for up to 3 doses (maximum daily dose: 0.5 mg/kg/day) is approved in Canada and Europe (Ref).

Gastroesophageal reflux, treatment

Gastroesophageal reflux, treatment: Note: Routine use is not recommended; reserve use as a last resort after all other therapies have failed and following consultation with a GI specialist (Ref). Limited data available; efficacy results variable:

Infants, Children, and Adolescents: Oral: 0.1 to 0.2 mg/kg/dose every 6 to 8 hours; maximum dose: 10 mg/dose (Ref).

Postoperative nausea and vomiting, prevention

Postoperative nausea and vomiting (PONV), prevention: Limited data available; optimal dose not established; efficacy results variable:

Note: Guidelines do not include metoclopramide as a therapeutic option for pediatric patients; other agents have shown superior efficacy with fewer adverse reactions(Ref).

Children and Adolescents: IV: 0.1 to 0.25 mg/kg/dose as a single dose administered after induction or on arrival to postanesthesia care unit; maximum dose: 10 mg/dose (Ref). Note: Although higher doses have been reported for PONV, use may be associated with an increased risk of adverse effects (Ref).

Postpyloric feeding tube placement

Postpyloric feeding tube placement (small bowel intubation): Note: Use in patients who have failed conventional measures.

Infants and Children <6 years: IV: 0.1 mg/kg as a single dose.

Children ≥6 years and Adolescents ≤14 years: IV: 2.5 to 5 mg as a single dose.

Adolescents ≥15 years: IV: 10 mg as a single dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: The following adjustments have been recommended (Ref). Note: Renally adjusted dose recommendations are based on IV or oral doses of 0.1 to 0.2 mg/kg/dose every 6 to 8 hours.

GFR >50 mL/minute/1.73 m2: No adjustment necessary.

GFR 30 to 50 mL/minute/1.73 m2: Administer 75% of dose.

GFR 10 to 29 mL/minute/1.73 m2: Administer 50% of dose.

GFR <10 mL/minute/1.73 m2: Administer 25% of dose.

Intermittent hemodialysis: Administer 25% of dose.

Peritoneal dialysis (PD): Administer 25% of dose.

Continuous renal replacement therapy (CRRT): Administer 75% of dose.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, metoclopramide has been used safely in adult patients with advanced liver disease with normal renal function.

Adverse Reactions (Significant): Considerations
CNS depression

Drowsiness, fatigue, lassitude, dizziness, and confusion have occurred with therapeutic and supratherapeutic dosing. These effects are self-limiting and usually resolve within 24 hours of drug discontinuation.

Mechanism: Dose-related; related to the pharmacologic action (ie, dopamine receptor antagonism).

Onset: Rapid; typically occurs within the first 5 days of use (median: 1 day) (Ref).

Risk factors:

• Age >65 years (Ref)

• Concurrent use of CNS depressants

• Kidney impairment

Extrapyramidal symptoms

Drug-induced extrapyramidal reaction may occur with metoclopramide. Acute dystonic reactions have occurred, such as involuntary limb movements, facial grimacing, torticollis, oculogyric crisis, rhythmic tongue protrusion, bulbar type of speech, trismus, or dystonic reactions resembling tetanus. Stridor and dyspnea occurred rarely. Acute dystonic reactions are generally reversible with drug discontinuation and may require intervention. Akathisia (motor restlessness), manifesting as feelings of anxiety, agitation, insomnia, inability to sit still, pacing, and foot tapping has occurred. Akathisia is generally reversible with drug discontinuation or dose reduction. Parkinsonism symptoms, such as bradykinesia, tremor, cogwheel rigidity, and mask-like facies, have occurred after longer courses of therapy. Parkinsonian symptoms generally resolve within 2 to 3 months after drug discontinuation. Tardive dyskinesia (TD), a syndrome of disfiguring involuntary movements of the face, tongue, trunk, and/or extremities, has occurred. These effects are potentially irreversible; however, symptoms may decrease or resolve after drug discontinuation in some patients (Ref). Earlier detection of TD with immediate drug discontinuation may correspond to a higher likelihood of reversibility.

Mechanism: Dose- and time-related; related to the pharmacologic action (ie, dopamine receptor antagonism) (Ref).

Onset:

• Acute dystonia: Rapid; usually occurs within the first 24 to 48 hours of therapy initiation

• Akathisia: Rapid; usually occurs within the first few hours of therapy initiation, but can occur up to 48 hours after drug administration (Ref)

• Parkinsonism: Delayed; typically occurs within the first 6 months of therapy, but may present after longer periods

• Tardive dyskinesia: Delayed; typically occurs after the first 12 weeks of therapy

Risk factors:

General:

• Higher than recommended doses (Ref)

• Longer durations of therapy (>12 weeks)

• Age ≥60 years (Ref) and pediatric patients

• Females

• Kidney impairment

• Diabetes mellitus

• Concurrent use of other drugs that can cause extrapyramidal symptoms (eg, antipsychotics)

• Concurrent use of strong CYP2D6 inhibitors (eg, fluoxetine, paroxetine, bupropion) (Ref)

• CYP2D6 poor metabolizers

Specific:

• Acute dystonia: Age <30 years

• Akathisia: Rapid intravenous administration (eg, IV bolus over 2 minutes) (Ref)

• Parkinsonism: History of Parkinson disease, concurrent use of dopamine agonists and drugs that increase dopamine

Hyperprolactinemia

Galactorrhea not associated with childbirth, amenorrhea, gynecomastia, and erectile dysfunction have occurred. These effects are generally reversible after drug discontinuation. Although drug-induced hyperprolactinemia is usually associated with prolactin levels of 25 to 100 mcg/L, metoclopramide use may lead to prolactin levels higher than 200 mcg/L (Ref). While many reports of symptomatic hyperprolactinemia have corresponded with elevated prolactin levels, symptoms despite normal prolactin levels have also been described (Ref).

Mechanism: Related to the pharmacologic action (ie, dopamine receptor antagonism).

Onset: Varied; may occur within the first week of therapy up to 4 months after therapy initiation (Ref).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Gastrointestinal: Dysgeusia (nasal spray: 15%)

Nervous system: Drowsiness (~10% to 70%; dose related), dystonic reaction (≤25%; dose and age related)

1% to 10%: Nervous system: Fatigue (~10%; dose related), lassitude (~10%; dose related), restlessness (~10%; dose related)

Frequency not always defined:

Cardiovascular: Atrioventricular block, bradycardia, flushing (following high IV doses), hypertension (severe) (Leonard 2018), hypotension (rare) (Nguyen 2013), supraventricular tachycardia

Dermatologic: Skin rash, urticaria

Endocrine & metabolic: Amenorrhea, endocrine disease (elevation of aldosterone), fluid retention, galactorrhea not associated with childbirth, hyperprolactinemia, porphyria

Gastrointestinal: Change in bowel habits, diarrhea, nausea

Genitourinary: Urinary frequency, urinary incontinence

Hematologic & oncologic: Leukopenia, methemoglobinemia, neutropenia

Hypersensitivity: Tongue edema

Nervous system: Confusion, dizziness, hallucination, headache, insomnia, seizure

Neuromuscular & skeletal: Laryngospasm (rare)

Ophthalmic: Visual disturbance

Respiratory: Bronchospasm, laryngeal edema

Postmarketing:

Cardiovascular: Cardiac failure (Ahmad 1991), sinoatrial arrest (usually with rapid IV administration or higher doses) (Malkoff 1995)

Endocrine & metabolic: Gynecomastia (Madani 1997)

Hematologic & oncologic: Agranulocytosis (Manoharan 1998), sulfhemoglobinemia (Van Veldhuizen 1996)

Hypersensitivity: Angioedema (Pietrzko 2013)

Nervous system: Akathisia (rare: <1%) (Qiu 2011; Van Gool 2010), depression (Dahl 2014), drug-induced extrapyramidal reaction (rare: <1%) (Rao 2010; Tsai 2018), neuroleptic malignant syndrome (Whittman 2016), parkinsonism (rare: <1%) (Sethi 1989), suicidal ideation (Surawski 2011), tardive dyskinesia (total cumulative dose and duration of treatment related; rare: <1%) (Al-Saffar 2019)

Contraindications

Hypersensitivity (eg, laryngeal and glossal angioedema, bronchospasm) to metoclopramide or any component of the formulation; situations where stimulation of gastrointestinal (GI) motility may be dangerous, including mechanical GI obstruction, perforation, or hemorrhage (except when used prior to endoscopy for evaluation of acute upper GI bleeding [Barkun 2010]); pheochromocytoma or other catecholamine-releasing paragangliomas; seizure disorder (eg, epilepsy); history of tardive dyskinesia or dystonic reaction to metoclopramide; concomitant use with other agents likely to increase extrapyramidal reactions.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in the US labeling): Infants <1 year of age.

Warnings/Precautions

Concerns related to adverse effects:

• Hypertension: May elevate BP; avoid use in patients with hypertension (IV administration was shown to release catecholamines). There are reports of hypertensive crises in patients with undiagnosed pheochromocytoma (Leonard 2018).

Disease-related concerns:

• Cancer (eg, breast cancer): The clinical significance of hyperprolactinemia in patients with breast cancer or other prolactin-dependent tumors is unknown.

• Edematous conditions: Use with caution in patients who are at risk of fluid overload (HF, cirrhosis). Metoclopramide causes a transient increase in serum aldosterone and increases the risk for fluid retention and volume overload.

• Hepatic impairment: Use caution in patients with moderate to severe hepatic impairment; risk of adverse reactions may be increased due to increased systemic exposure. Use of nasal formulation is not recommended since dose is not easily adjusted to reduce exposure.

• Nicotinamide adenine dinucleotide hydrogen (NADH)-cytochrome b5 reductase deficiency: Patients with NADH-cytochrome b5 reductase deficiency are at increased risk of methemoglobinemia and/or sulfhemoglobinemia.

• Parkinson disease: Symptoms of Parkinson disease may be exacerbated; avoid use in patients with Parkinson disease and other patients being treated with antiparkinsonian drugs.

• Renal impairment: Use with caution in patients with moderate to severe renal impairment; risk of adverse reactions may be increased due to increased systemic exposure. Use of nasal formulation is not recommended since dose is not easily adjusted to reduce exposure.

• Surgical anastomosis/closure: Use with caution following surgical anastomosis/closure; promotility agents may theoretically increase pressure in suture lines.

Special populations:

• CYP2D6 poor metabolizers: Elimination of metoclopramide may be slowed possibly increasing the risk of dystonic and other adverse reactions; dosage reduction recommended.

• Pediatric: Not recommended for use (nasal/oral formulations) due to increased risk of tardive dyskinesia and other extrapyramidal symptoms as well as the risk of methemoglobinemia in neonates (neonates may have decreased levels of NADH-cytochrome b5 reductase, which increases the risk of methemoglobinemia).

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.

Warnings: Additional Pediatric Considerations

Metoclopramide is not recommended for the management of gastroesophageal reflux in pediatric patients due to increased risk of adverse events and lack of data showing efficacy (AAP [Eichenwald 2018]; NASPGHAN/ESPGHAN [Rosen 2018]); other therapeutic agents should be considered.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection:

Generic: 5 mg/mL (2 mL)

Solution, Injection [preservative free]:

Generic: 5 mg/mL (2 mL)

Solution, Nasal:

Gimoti: 15 mg/actuation (9.8 mL) [contains benzalkonium chloride, edetate (edta) disodium dihydrate]

Solution, Oral:

Generic: 5 mg/5 mL (10 mL [DSC], 473 mL); 10 mg/10 mL (10 mL, 473 mL)

Tablet, Oral:

Reglan: 5 mg [contains fd&c blue #1 (brill blue) aluminum lake, quinoline (d&c yellow #10) aluminum lake]

Reglan: 10 mg [dye free]

Generic: 5 mg, 10 mg

Tablet Disintegrating, Oral:

Generic: 5 mg, 10 mg [DSC]

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Gimoti Nasal)

15 mg/ACT (per mL): $258.73

Solution (Metoclopramide HCl Injection)

5 mg/mL (per mL): $0.71 - $2.01

Solution (Metoclopramide HCl Oral)

5 mg/5 mL (per mL): $0.21 - $1.27

Tablet, orally-disintegrating (Metoclopramide HCl Oral)

5 mg (per each): $9.49

Tablets (Metoclopramide HCl Oral)

5 mg (per each): $0.32 - $0.90

10 mg (per each): $0.28 - $0.96

Tablets (Reglan Oral)

5 mg (per each): $4.68

10 mg (per each): $4.68

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Injection:

Generic: 5 mg/mL (2 mL, 10 mL, 30 mL)

Solution, Oral:

Generic: 5 mg/5 mL (250 mL, 500 mL)

Tablet, Oral:

Metonia: 10 mg

Generic: 5 mg

Administration: Adult

Injection: May be given IM, direct IV push, short infusion (at least 15 minutes), or continuous infusion; lower doses (≤10 mg) of metoclopramide can be given IV push undiluted over 1 to 2 minutes; higher doses (>10 mg) to be diluted in 50 mL of compatible solution (preferably NS) and given IVPB over at least 15 minutes. Note: Rapid IV administration may be associated with a transient (but intense) feeling of anxiety and restlessness, followed by drowsiness.

Nasal: For intranasal administration only. Prime pump (press 10 times until spray appears) prior to first use or if spray unused ≥2 weeks. Insert applicator into nostril, tilt head slightly forward keeping bottle upright, and close off the other nostril. Breathe in through nose. While inhaling, press pump to release spray; exhale through mouth. Avoid spraying directly into nasal septum, eyes, or mouth. After each use, wipe the spray tip with a clean tissue and replace cap. If the spray nozzle gets clogged, clean by removing nozzle and soaking in warm water; do not insert a pin or other sharp object into the nozzle. Discard after 4 weeks, even if bottle is not completely empty.

Tablets and oral solution: For scheduled dosing, administer 30 minutes prior to meals and at bedtime.

Orally disintegrating tablets: For scheduled dosing, administer on an empty stomach at least 30 minutes prior to food and at bedtime (do not repeat if inadvertently taken with food). Do not remove from packaging until time of administration. If tablet breaks or crumbles while handling, discard and remove new tablet. Using dry hands, place tablet on tongue and allow to dissolve (disintegrates within ~1 minute [range: 10 seconds to 14 minutes]). Swallow with saliva (formulation is designed to be taken without liquids).

SUBQ administration (off-label route) has been reported, either as an intermittent bolus injection or as continuous infusion (Ref).

Administration: Pediatric

Oral: Oral solution, tablet: Administer 30 minutes before meals and at bedtime.

Parenteral:

IM: May be administered IM.

IV: Note: Rapid IV administration is associated with a transient but intense feeling of anxiety and restlessness, followed by drowsiness.

IV push: For doses ≤10 mg may be administered undiluted (5 mg/mL) by direct IV push over 1 to 2 minutes.

Intermittent IV infusion: For higher doses (>10 mg), dilute dose prior to use and administer over at least 15 minutes.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Gimoti: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/209388s001lbl.pdf#page=17

Metoclopramide oral solution: https://www.fda.gov/media/80163/download

Metozolv ODT: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/022246s009lbl.pdf#page=18

Reglan injection: https://www.fda.gov/media/77375/download

Reglan ODT: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021793s011mg.pdf

Reglan tablet: https://www.fda.gov/media/79804/download

Use: Labeled Indications

Injection:

Chemotherapy-induced nausea and vomiting, prophylaxis: Prophylaxis of nausea and vomiting associated with emetogenic cancer chemotherapy. Note: Injectable metoclopramide prior to moderate- to high-emetic-risk chemotherapy is rarely indicated due to the potential for neurologic events and availability of more efficacious alternative agents.

Gastroparesis, diabetic: Relief of symptoms associated with acute and recurrent diabetic gastroparesis.

Postoperative nausea and vomiting, prophylaxis: Prophylaxis of postoperative nausea and vomiting in circumstances where nasogastric suction is undesirable.

Note: Although included as an FDA-approved use in the manufacturer's labeling for prevention of postoperative nausea and vomiting, available data to support use in this condition are limited (De Oliveira 2012; Gan 2020; Weibel 2021). Use may be considered when dopamine antagonists are indicated but other preferred agents in this class (eg, droperidol) cannot be used (Gan 2020).

Small bowel intubation (postpyloric feeding tube placement): Facilitation of small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers (within 10 minutes).

Note: Although FDA approved for facilitation of postpyloric feeding tube placement, available data to support use in this condition are limited. Systematic reviews have not shown an association between metoclopramide administration and successful postpyloric tube placement and overall quality of evidence is low; however, some individual studies have shown benefit (Hu 2018; Ouyang 2022; Silva 2015).

Nasal:

Gastroparesis, diabetic: Relief of symptoms associated with acute and recurrent diabetic gastroparesis in adults.

Oral:

Gastroesophageal reflux disease, refractory: Short-term (4 to 12 weeks) treatment in adults with documented symptomatic gastroesophageal reflux disease (GERD) who fail to respond to conventional therapy.

Note: May use metoclopramide as an adjunctive therapy only if gastroparesis is confirmed. The American College of Gastroenterology (ACG) guidelines for the treatment of GERD recommend that diagnostic evaluation to confirm underlying gastroparesis be performed prior to considering the use of prokinetic agents (ACG [Katz 2013]). Furthermore, American Gastroenterological Association (AGA) guidelines for the treatment of GERD recommend against the use of metoclopramide as monotherapy or adjunctive therapy in patients with GERD (AGA [Kahrilas 2008]).

Gastroparesis, diabetic: Relief of symptoms associated with acute and recurrent diabetic gastroparesis in adults.

Use: Off-Label: Adult

Aspiration prophylaxis in patients undergoing anesthesia; Bowel obstruction (partial), malignant inoperable; Chemotherapy-induced nausea and vomiting, prophylaxis of delayed emesis (high-risk regimen); Dyspepsia, functional (refractory); Gastroparesis, nondiabetic; Hiccups; Medication-overuse headache or intractable migraine (status migrainosus); Migraine, severe, acute treatment (emergency setting); Nausea and vomiting: Advanced cancer-associated; Nausea and vomiting: Pregnancy-associated, severe or refractory; Nausea and/or vomiting: Undifferentiated or due to a variety of medical conditions associated with acute self-limiting nausea/vomiting; Nausea and vomiting: Vertigo-associated; Radiation therapy-induced nausea and vomiting (rescue therapy); Tension-type headache, acute (emergency setting)

Medication Safety Issues
Sound-alike/look-alike issues:

Metoclopramide may be confused with metOLazone, metoprolol, metroNIDAZOLE

Reglan may be confused with Megace, Regonol, Renagel, Regitine

Older Adult: High-Risk Medication:

Beers Criteria: Metoclopramide is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (unless used for the treatment of gastroparesis with treatment duration <12 weeks, except in rare cases) due to its potential for causing extrapyramidal effects, including tardive dyskinesia; these risks may be increased in frail older adults and with longer treatment duration (Beers Criteria [AGS 2023]).

Pediatric patients: High-risk medication:

KIDs List: Dopamine antagonists, when used in pediatric patients <18 years of age, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided in infants and used with caution in children and adolescents due to risk of acute dystonia (dyskinesia), and with intravenous administration an increased risk of respiratory depression, extravasation, and death (weak recommendation; moderate quality of evidence) (PPA [Meyers 2020]).

Metabolism/Transport Effects

Substrate of CYP1A2 (minor), CYP2D6 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Ajmaline: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Anticholinergic Agents: May diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy

Anti-Parkinson Agents (Dopamine Agonist): Metoclopramide may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Risk X: Avoid combination

Antipsychotic Agents: Metoclopramide may enhance the adverse/toxic effect of Antipsychotic Agents. Risk X: Avoid combination

Artemether and Lumefantrine: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Atovaquone: Metoclopramide may decrease the serum concentration of Atovaquone. Management: Consider alternatives to metoclopramide when possible; atovaquone should only be used with metoclopramide if no other antiemetics are available. Risk D: Consider therapy modification

Cabergoline: May diminish the therapeutic effect of Metoclopramide. Metoclopramide may diminish the therapeutic effect of Cabergoline. Risk X: Avoid combination

CNS Depressants: Metoclopramide may enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

CycloSPORINE (Systemic): Metoclopramide may increase the serum concentration of CycloSPORINE (Systemic). Risk C: Monitor therapy

CYP2D6 Inhibitors (Moderate): May increase the serum concentration of Metoclopramide. Risk C: Monitor therapy

CYP2D6 Inhibitors (Strong): May increase the serum concentration of Metoclopramide. Management: For gastroparesis: reduce metoclopramide dose to 5mg 4 times/day and limit to 20mg/day; nasal spray not recommended. For GERD: reduce metoclopramide dose to 5mg 4 times/day or to 10mg 3 times/day and limit to 30mg/day. Monitor for toxicity when combined. Risk D: Consider therapy modification

Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Risk C: Monitor therapy

Deutetrabenazine: May enhance the adverse/toxic effect of Metoclopramide. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased. Risk C: Monitor therapy

DiazePAM: Metoclopramide may enhance the CNS depressant effect of DiazePAM. Metoclopramide may increase the serum concentration of DiazePAM. Risk C: Monitor therapy

Digoxin: Metoclopramide may decrease the serum concentration of Digoxin. Risk C: Monitor therapy

DroPERidol: May enhance the adverse/toxic effect of Metoclopramide. Risk X: Avoid combination

Fosfomycin: Gastrointestinal Agents (Prokinetic) may decrease the serum concentration of Fosfomycin. Risk C: Monitor therapy

Levosulpiride: Benzamide Derivatives may enhance the adverse/toxic effect of Levosulpiride. Risk C: Monitor therapy

Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy

MetyroSINE: May enhance the adverse/toxic effect of Metoclopramide. Risk X: Avoid combination

Mivacurium: Metoclopramide may enhance the neuromuscular-blocking effect of Mivacurium. Risk C: Monitor therapy

Monoamine Oxidase Inhibitors: Metoclopramide may enhance the hypertensive effect of Monoamine Oxidase Inhibitors. Risk X: Avoid combination

Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy

Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Posaconazole: Metoclopramide may decrease the serum concentration of Posaconazole. Risk C: Monitor therapy

Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy

Promethazine: Metoclopramide may enhance the adverse/toxic effect of Promethazine. Risk X: Avoid combination

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Quinagolide: Metoclopramide may diminish the therapeutic effect of Quinagolide. Risk C: Monitor therapy

Rivastigmine: May enhance the adverse/toxic effect of Metoclopramide. Specifically, the risk of extrapyramidal adverse reactions may be increased with this combination. Risk X: Avoid combination

Serotonergic Agents (High Risk): Metoclopramide may enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Consider monitoring for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor therapy

Sirolimus (Conventional): Gastrointestinal Agents (Prokinetic) may increase the serum concentration of Sirolimus (Conventional). Risk C: Monitor therapy

Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy

Succinylcholine: Metoclopramide may enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Tacrolimus (Systemic): Metoclopramide may increase the serum concentration of Tacrolimus (Systemic). Specifically, treatment of gastroparesis may increase tacrolimus concentrations. Risk C: Monitor therapy

Tetrabenazine: Metoclopramide may enhance the adverse/toxic effect of Tetrabenazine. Risk X: Avoid combination

Thiopental: Metoclopramide may enhance the therapeutic effect of Thiopental. Management: Consider thiopental dose reduction when used concomitantly with metoclopramide. Monitor patient response to treatment closely if using this combination. Risk D: Consider therapy modification

Trimetazidine: Metoclopramide may enhance the adverse/toxic effect of Trimetazidine. Specifically, the risk of extrapyramidal symptoms may be enhanced. Risk X: Avoid combination

Triptorelin: Hyperprolactinemic Agents may diminish the therapeutic effect of Triptorelin. Risk X: Avoid combination

Reproductive Considerations

Metoclopramide may increase prolactin concentrations; hyperprolactinemia may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotropin secretion which may inhibit reproductive function by impairing gonadal steroidogenesis. Amenorrhea and impotence have been reported.

Pregnancy Considerations

Metoclopramide crosses the placenta and can be detected in cord blood and amniotic fluid (Arvela 1983; Bylsma-Howell 1983).

Based on available data, information related to the risk of major malformations following in utero exposure to metoclopramide is inconsistent (Ishikawa 2022; Sun 2021). Extrapyramidal symptoms or methemoglobinemia may potentially occur in the neonate.

Drug-induced acute dystonic reactions have been reported following use of metoclopramide in nonpregnant and pregnant patients; maternal CYP2D6 metabolizer status and hormonal changes that occur during pregnancy may contribute to this risk (Chua 2019).

Metoclopramide is one of the agents that may be considered for adjunctive treatment of nausea and vomiting in pregnant patients when symptoms persist following initial pharmacologic therapy. Oral or IM therapy may be given in patients who are not dehydrated; IV therapy should be used when dehydration is present (ACOG 189 2018). Metoclopramide may be used for prophylaxis of nausea and vomiting associated with cesarean delivery (ASA 2016; Smith 2011). Metoclopramide has also been used for the treatment of acute or tension headache in pregnant patients when acetaminophen is not effective (Childress 2018; Hamilton 2019).

Breastfeeding Considerations

Metoclopramide is present in breast milk.

Information related to the presence of metoclopramide in breast milk is available from multiple studies (Hansen 2005; Kauppila 1983; Lewis 1980).

• One study included mothers with treatment initiated between 3 and 9 days' postpartum (early puerperium, n = 5) or 8 and 12 weeks' postpartum (late puerperium, n = 18). All patients in the study were administered metoclopramide 10 mg three times daily for 2 weeks. The highest concentration of metoclopramide in breast milk (0.1565 mcg/mL) was noted after 4 days of treatment in an early puerperium mother. The mean breast milk concentration in the late puerperium group was 0.0479 mcg/mL ± 0.0265 mcg/mL. Peak breast milk concentrations appeared approximately the same time as peak maternal serum concentrations, 2 to 3 hours after the dose. Metoclopramide was also detected in the serum of one breastfeeding infant (Kauppila 1983).

• Using a milk concentration of 0.1565 mcg/mL, the estimated exposure to the breastfeeding infant would be 0.023 mg/kg/day (relative infant dose ~4.6% based on a therapeutic infant dose of 0.5 mg/kg/day).

• According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. However, in general, breastfeeding is considered acceptable when the relative infant dose of a medication is <10% (Anderson 2016; Ito 2000).

Although not commonly reported, transient intestinal discomfort has been noted in two breastfed infants following exposure via breast milk (Zuppa 2010). Depression and headache have been reported in some lactating women; other adverse events reported in the mother are similar to those reported following metoclopramide use for labeled indications (Shen 2021).

Infants exposed to metoclopramide via breast milk should be monitored for extrapyramidal symptoms or methemoglobinemia. When treatment for maternal nausea and vomiting is needed, the WHO recommends metoclopramide be avoided due to insufficient data on long-term side effects to the infant (WHO 2002).

Metoclopramide may increase prolactin concentrations and cause galactorrhea and gynecomastia. As such, it has been evaluated as a galactagogue in women with insufficient milk supply. Based on pooled data from available studies, it is unclear if milk production is increased over placebo; use may be less effective following delivery of preterm infants (Foong 2020; Shen 2021). Case reports describe the use of metoclopramide (in combination with other therapies) to induce lactation in adoptive patients who wish to breastfeed (Cazorla-Ortiz 2020).

Due to the potential for adverse maternal events, a full evaluation for medical causes of low milk supply and nonpharmacologic measures should be considered prior to the use of medications as galactagogues. The Academy of Breastfeeding Medicine (ABM) does not recommend use of any specific galactagogue due to inconclusive data and potential adverse effects. Metoclopramide is associated with potentially serious adverse events in the mother. If used, dose and duration of therapy should be limited (ABM [Brodribb 2018]). Avoid use in patients at increased risk for depression (Shen 2021).

Monitoring Parameters

Signs of tardive dyskinesias, extrapyramidal symptoms; signs/symptoms of neuroleptic malignant syndrome; mental alertness.

Mechanism of Action

Metoclopramide blocks dopamine receptors and (when given in higher doses) also blocks serotonin receptors in chemoreceptor trigger zone of the CNS; enhances the response to acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions; increases lower esophageal sphincter tone

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Oral: 30 to 60 minutes; IV: 1 to 3 minutes; IM: 10 to 15 minutes.

Duration: Therapeutic: 1 to 2 hours, regardless of route.

Absorption: Oral: Rapid, well absorbed.

Metabolism: Hepatic via oxidation and glucuronide and sulfate conjugation; forms oxidative metabolite monodeethylmetoclopramide via CYP2D6.

Distribution: Vd: Neonates, PMA 31 to 40 weeks: 6.94 L/kg (Kearns 1998); Infants: 4.4 L/kg; Children: 3 L/kg; Adults: ~3.5 L/kg.

Protein binding: ~30%.

Bioavailability: Nasal: 47%; Oral: 80% ± 15.5%.

Half-life elimination: Normal renal function: Neonates, PMA 31 to 40 weeks: 5.4 hours (Kearns 1998); Infants: 4.15 hours (range: 2.23 to 10.3 hours) (Kearns 1988); Children: ~4 hours (range: 2 to 12.5 hours); half-life and clearance may be dose-dependent; Adults: 5 to 6 hours (may be dose dependent); Nasal: ~8 hours.

Time to peak, serum: Neonates, PMA 31 to 40 weeks: 2.45 hours (Kearns 1998); Infants: 2.2 hours; Adults: 1 to 2 hours.

Excretion: Urine (~85%); feces.

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: AUC increased ~2-fold in patients with moderate to severe renal impairment and ~3.5 fold in patients with ESRD on dialysis.

Hepatic function impairment: Clearance was reduced by ~50% in patients with severe hepatic impairment.

CYP2D6 poor metabolizers: Elimination may be slowed.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Gastrobid | Meclopran | Paspertin | Plasil | Premosan | Primperan | Pylomid;
  • (AR) Argentina: Fada metoclopramida/celit | Fonderyl | Lizarona | Metoclopramida | Metoclopramida hlb | Metoclopramida larjan | Midatenk | Novomit | Pepsipancreol | Primavera-n | Primperil | Reliveran | Rilaquin | Rupemet | Trimpol;
  • (AT) Austria: Gastrosil | Metoclopramidhydrochlorid Accord | Metogastron | Paspertin;
  • (AU) Australia: Apo-metoclopramide | Emexlon | Maxolon | Metoclopramide | Metoclopramide actavis | Metoclopramide an | Metoclopramide rbx | Pramin;
  • (BD) Bangladesh: Antimet | Flatelon | Flatilon | Maxil | Maxocol | Meclid | Mepralon | Metocil | Metocol | Metomid | Motilon | Movlan | Nutramid;
  • (BE) Belgium: Docmetoclo | Metoclopramide efeka | Mobistal | Primperan;
  • (BF) Burkina Faso: Pradis;
  • (BG) Bulgaria: Cerucal | Degan | Paspertin | Reglan;
  • (BR) Brazil: Cloridrato de metoclopramida | Emetic | Enzilom | Eucil | Furp metoclopramid | Furp metoclopramida | Hyposil | Istasil | Metoclosan | Metoplamin | Nausil | Noprosil | Novosil | Plabel | Plagex | Plamidasil | Plamivon | Plasil | Pramil | Remetin | Vomistop | Vonil;
  • (CH) Switzerland: Gastrosil | Paspertin | Primperan;
  • (CL) Chile: Hemibe | Itan | Metoclopramida | Peryan;
  • (CN) China: Metoclopramide;
  • (CO) Colombia: Bonadoxina | Bondigest | Carnotprim | Digespar | Enzimar | Enzimar nf | Metoclopramida | Metroprasil | Novomit | Plasil | Primperan;
  • (CZ) Czech Republic: Cerucal | Degan | Mcp Hexal | Paspertin | Primperan | Reglan;
  • (DE) Germany: Cerucal | Dura mcp | Gastronerton | Gastrotranquil | Maltyl | Mcp 1a pharma | Mcp abz | Mcp al | Mcp heumann | Mcp Hexal | Mcp ratiopharm | Mcp stada | Mcpham | Metoclopramid | Paspertin;
  • (DO) Dominican Republic: Clo-Prim | Clopafar | Clopramin | Metagliz | Metoclopramida | Pramin | Primperan | Propace;
  • (EC) Ecuador: Clodopan | Clopan | Clopral | Metoclopramida | Metoclox | Primperan;
  • (EE) Estonia: Cerucal | Cerucale-v | Mcp ratiopharm | Metoclopramid | Metoclopramide | Metoclopramide Accord;
  • (EG) Egypt: Clopram | Meclopram | Metoclopramide | Migaura | Plasil | Plemazol | Primperan;
  • (ES) Spain: Metoclopramida accord | Metoclopramida pensa | Primperan;
  • (ET) Ethiopia: Metoclopramide | Premosan | Regurg;
  • (FI) Finland: Emperal | Metoclopramide Accord | Metoclopramide orion | Metopram | Primperan;
  • (FR) France: Anausin | Anausin Metoclopramide | Metoclopramide | Metoclopramide Dci | Metoclopramide gnr | Primperan | Sorbiperan;
  • (GB) United Kingdom: Gastrese | Gastrobid | Maxolon | Metoclomex | Metoclopramide | Metoclopramide cox | Metoclopramide dc | Metox | Metramid | Mygdalon | Parmid | Primperan;
  • (GR) Greece: Primperan;
  • (HK) Hong Kong: Apo-Metoclop | Bf-Metoclopramide | Clopamon | Cloperan | Clopramel | Hawkperan | Ma | Maril | Martomide | Maxolon | Mecloma | Metoclopramide | Metolon | Metomide | Metram | Primperan | Prowel | Pulin | Sinprim | Syntomide;
  • (HR) Croatia: Metopran | Reglan;
  • (HU) Hungary: Cerucal | Paspertin;
  • (ID) Indonesia: Clopramel | Damaben | Emeran | Enakur | Ethiferan | Gavistal | Hufaclop | Lexapram | Mepramide | Metoclopramide | Metolon | Navoren | Nilatika | Nofoklam | Noristal | Normastin | Omevomid | Opram | Piralen | Plasil | Praminal | Primperan | Raclonid | Reguloop | Sanmeto | Sotatic | Tomit | Topram | Vertivom | Vilapon | Vomiles | Vomipram | Vomitrol | Vosea | Zumatrol;
  • (IE) Ireland: Antimet | Gastrobid | Maxolon | Metocyl | Primperan;
  • (IL) Israel: Pramin;
  • (IN) India: Almeto | Emenil | Emenorm | Maxeron | Maxinorm | Metanorm | Metochlopramide | Metoclopramide | Metocontin | Metonorm | Metotid | Perinorm | Promet | Reggi | Reglan | Sigmet | Vominorm;
  • (IQ) Iraq: Meclodin | Meclokindin | Vomisaf;
  • (IT) Italy: Metoclopramide Accord | Plasil | Pramidin;
  • (JO) Jordan: Clopram | Damperide | Elitan | Gastroprid | Plasil | Primperan | Pylomid;
  • (JP) Japan: Anolexinon | Donopon gp | Elieten | Emperan | Folicron | Gaputazis | Gosper m | Metoclol | Metoclopramide | Metoclopramide tsuruhara | Moriperan | Peraprin | Pramiel | Primperan | Prinparl | Prometin | Putoprin | Terperan;
  • (KE) Kenya: Asmeto | Cloperan | Emeton | Gastrolon | Melasil | Metcos | Primperan;
  • (KR) Korea, Republic of: Gasrobi | Macperan | Metocron | Mexolon | Prometin | Sinil metoclopramide;
  • (KW) Kuwait: Gastrobid | Maxolon | Metocyl | Premosan | Primperan | Pylomid;
  • (LB) Lebanon: Gastropride | Primperan;
  • (LT) Lithuania: Apo metoclop | Cerucal | Degan | Emperal | Metamol | Metoclopramide | Metoclopramide bp | Nevomitan | Paspertin | Reglan;
  • (LU) Luxembourg: Gastrosil | Mcp Hexal | Mcp ratiopharm | Movistal | Primperan;
  • (LV) Latvia: Apo metoclop | Cerucal | Degan | Emperal | Metoclopramide | Paspertin | Reglan;
  • (MA) Morocco: Cloprame | Metagliz | Primperan | Sorbiperan | Vomistop;
  • (MX) Mexico: Biopram | Camiprida | Carnotprim | Cirulan | Clopramid | Conysmin | Dirpasid | Dolmisin | Eslinmor | Eudiges | Gigemet | Goyodem | Hopram | Meclomid | Metoclopram | Metoclopram biomep | Metoclopram bruluart | Metoclopram gi | Metoclopram gi ly | Metoclopram provacs | Metoclopram Ultra | Metoclopram wyeth | Metoclopramida | Metoclopramida Loeffler | Metoclopramida Novartis | Metoclopramida Proquigama | Metoclopramida Raam | Metoril | Mipramid | Plasil | Polcotec | Pradex | Pramilem | Primier | Primperan | Propace | Synespramid | Tinolpro;
  • (MY) Malaysia: Anpro Metoclopramide | Antimet | Axcel Metoclopramide | Emecon | Emeliv | Gastrolon | Maril | Maxolon | Metoclopramide | Metocyl | Metolon | Metomide | Mexomide | Primperan | Pulin | Setromide;
  • (NL) Netherlands: Metoclopramide HCL | Metoclopramide hcl Alpharma | Metoclopramide Hcl CF | Metoclopramide Hcl PCH | Metoclopramide hcl ratiopharm | Metoclopramidemonohydrochloride accord | Primperan;
  • (NO) Norway: Afipran | Metoclopramide Accord | Metoclopramide euromedica | Metoclopramide nmd grossist | Metoclopramide orifarm | Primperan;
  • (NZ) New Zealand: Maxolon | Metamide | Metoclopramide | Metoclopramide actavis | Metoclopramide baxter;
  • (PE) Peru: Apo-metoclopramida | Fluxt | Hemesys | Metoclopramida | Primperan;
  • (PH) Philippines: Meto | Metoclopramide | Myclosil | Pasclomet | Paspertin | Plasil | Rafromide | Reglan;
  • (PK) Pakistan: Clopan | Cloprel | Gastrolon | Gastrusil | Kanamide | Maxaclor | Maxolon | Mecomide | Mediclop | Metalon | Metoclon | Metoclop | Metoclopramide | Metomide | Plasil | Regelan | Stomac | Unexolon | Vomilide;
  • (PL) Poland: Cerucal | Degan | Metoclopramide | Metoclopramidum polpharma | Passpertin;
  • (PR) Puerto Rico: Metoclopramide | Metoclopramide HCL | Reglan;
  • (PT) Portugal: Mecloprina | Metgen | Metoclopramida | Primperan;
  • (PY) Paraguay: Digesplen | Emelit | Glicimet | Imperan | Reliveran;
  • (QA) Qatar: Apo-Metoclop | Cloperan | Clopram | Metoram | Premosan | Premosan (Julphar) | Premosan Drops | Primperan | Riamide;
  • (RO) Romania: Cerucal | Degan | Metoclopramid;
  • (RU) Russian Federation: Apo metoclop | Cerucal | Ceruglan | Cerulan | Melomid | Metoclopramide | Metoclopramide velfarm | Metoclopramide-akr | Perinorm | Reglan | Vero metoclopramid;
  • (SA) Saudi Arabia: Metosil | Plasil | Premosan | Primperan | Pylomid;
  • (SE) Sweden: Metoclopramide Accord | Metoclopramide orifarm | Metoclopramide orion | Metoklopramid alternova | Primperan;
  • (SG) Singapore: Apo-Metoclop | Maril | Maxolon | Mecloma | Metoclopramide | Metocyl | Metolon | Primperan | Syntomide;
  • (SI) Slovenia: Reglan;
  • (SK) Slovakia: Cerucal | Degan | Paspertin;
  • (SL) Sierra Leone: Metoclop | Metoclopramide;
  • (TH) Thailand: Elitan | Emetal | Gensil | Hawkperan | K.b.meta | Manosil | Maril | Maxolon | Mepamide | Meramide | Metoclopramide | Metoclor | Metono | Nausa | Nausil | Nausin | Noosea | Plamide | Plamine | Plasil | R J | Seapcosil | Tomed | Vasil | Vomesea | Vomitin | Vosil;
  • (TN) Tunisia: Mepramide | Pramidyl per os | Primperan;
  • (TR) Turkey: Metoklamid | Metpamid | Primperan;
  • (TW) Taiwan: Aswell | Balon | Biwesan | Chiaowelgen | Chitou | Dringen | Eline | Enteran | Imperam | Linperan | Meniperan | Mepram | Mepramide | Methoclopramide | Metoclopramide | Metoco | Metopelan | Metoperan | Metoperon | Mevaperan | Pantomide | Paspertin | Perone | Plasil | Plindan | Polun | Poriran | Prenperon | Prevomic | Primlan | Primperan | Primram | Primran | Prinparl | Pripram | Promeran | Prometin | Prowel | Pulin | Pulinpelin | Pulperan | Pusuan | Putelome | Rotelan | Rowelcon | Sinprim | Sinthato | Sinvomin | Suvecon | Suweilan | Torowilon | Wei Lian | Weiperan | Winperan | Zudaw | Zuperan;
  • (UA) Ukraine: Cerucal | Cerulan | Metamol | Metoclopramid | Metoclopramide | Metucal | Perinorm;
  • (UG) Uganda: Asmeto | Camet | Prasil;
  • (UY) Uruguay: Caillomida | Comportan | Legir | Metoclopramida | Novomit | Primperan | Revalidan;
  • (VE) Venezuela, Bolivarian Republic of: Clop | Irtopan | Mepramida | Metoclopramida | Pradamin | Pramide | Primperan;
  • (VN) Viet Nam: Meclopstad | Perimirane | Pimeran;
  • (ZA) South Africa: Ametic | Betaclopramide | Bio metoclopramide | Clopamon | Contromet | Maxolon | Merck-metoclopramide | Rolab-metoclopramide | Setin;
  • (ZM) Zambia: Metamide | Metoclopramide | Regurg;
  • (ZW) Zimbabwe: Clopamon | Metoclopramide
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Abas MN, Tan PC, Azmi N, Omar SZ. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1272-1279. doi: 10.1097/AOG.0000000000000242. [PubMed 24807340]
  3. Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
  4. Ahmad S. Metoclopramide-induced acute congestive heart failure. South Med J. 1991;84(2):283-284. doi:10.1097/00007611-199102000-00041 [PubMed 1990474]
  5. Al-Saffar A, Lennernäs H, Hellström PM. Gastroparesis, metoclopramide, and tardive dyskinesia: Risk revisited. Neurogastroenterol Motil. 2019;31(11):e13617. doi:10.1111/nmo.13617 [PubMed 31050085]
  6. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 189: Nausea and vomiting of pregnancy. Obstet Gynecol. 2018;131(1):e15-e30. doi:10.1097/AOG.0000000000002456. [PubMed 29266076]
  7. American Diabetes Association (ADA). Standards of medical care in diabetes–2023. Diabetes Care. 2023;46(suppl 1):S1-S4. https://care.diabetesjournals.org/content/44/Supplement_1. Accessed March 20, 2023.
  8. American Society of Anesthesiologists (ASA) Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270-300. [PubMed 26580836]
  9. American Society of Anesthesiologists (ASA) Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376-393. doi: 10.1097/ALN.0000000000001452. [PubMed 28045707]
  10. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  11. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007:116.
  12. Arvela P, Jouppila R, Kauppila A, et al. Placental transfer and hormonal effects of metoclopramide. Eur J Clin Pharmacol. 1983;24(3):345-348. [PubMed 6407846]
  13. Avery GB, Fletcher MA, MacDonald MG, eds. Neonatology - Pathophysiology and Management of the Newborn. 4th ed. J.B. Philadelphia, PA: Lippincott Company; 1994.
  14. Bakhshayesh B, Seyed Saadat SM, Rezania K, Hatamian H, Hossieninezhad M. A randomized open-label study of sodium valproate vs sumatriptan and metoclopramide for prolonged migraine headache. Am J Emerg Med. 2013;31(3):540-544. doi:10.1016/j.ajem.2012.10.014 [PubMed 23380105]
  15. Banani SJ, Lankarani KB, Taghavi A, Bagheri MH, Sefidbakht S, Geramizadeh B. Comparison of metoclopramide oral tablets and solution in treatment of dysmotility-like dyspepsia. Am J Health Syst Pharm. 2008;65(11):1057-1061. doi: 10.2146/ajhp070381. [PubMed 18499880]
  16. Barkun AN, Bardou M, Martel M, et al. Prokinetics in acute upper GI bleeding: a meta-analysis. Gastrointest Endosc. 2010;72(6):1138-1145. [PubMed 20970794]
  17. Barrett TW, DiPersio DM, Jenkins CA, et al. A randomized, placebo-controlled trial of ondansetron, metoclopramide, and promethazine in adults. Am J Emerg Med. 2011;29(3):247-255. doi: 10.1016/j.ajem.2009.09.028. [PubMed 20825792]
  18. Berardi RR, Cornish LA, Hyneck ML. Metoclopramide removal during continuous ambulatory peritoneal dialysis. Drug Intell Clin Pharm. 1986;20(2):154-155. doi:10.1177/106002808602000212 [PubMed 3948693]
  19. Berger J, Lester P, Rodrigues L. Medical therapy of malignant bowel obstruction with octreotide, dexamethasone, and metoclopramide. Am J Hosp Palliat Care. 2016;33(4):407-410. doi: 10.1177/1049909115569047. [PubMed 25646530]
  20. Berkovitch M, Mazzota P, Greenberg R, et al. Metoclopramide for nausea and vomiting of pregnancy: a prospective multicenter international study. Am J Perinatol. 2002;19(6):311-316. [PubMed 12357422]
  21. Berkow L. Rapid sequence induction and intubation (RSII) for anesthesia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  22. Bolton CM, Myles PS, Nolan T, Sterne JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth. 2006;97(5):593-604. [PubMed 17005507]
  23. Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. Am J Emerg Med. 2006;24(2):177-182. [PubMed 16490647]
  24. Brodribb W. ABM clinical protocol #9: use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med. 2018;13(5):307‐314. doi:10.1089/bfm.2018.29092.wjb [PubMed 29902083]
  25. Bruera E, Seifert L, Watanabe S, et al. Chronic nausea in advanced cancer patients: a retrospective assessment of a metoclopramide-based antiemetic regimen. J Pain Symptom Manage. 1996;11(3):147-153. [PubMed 8851371]
  26. Bylsma-Howell M, Riggs KW, McMorland GH, et al. Placental transport of metoclopramide: assessment of maternal and neonatal effects. Can Anaesth Soc J. 1983;30(5):487-492. [PubMed 6354385]
  27. Camilleri M. Treatment of gastroparesis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  28. Camilleri M, Kuo B, Nguyen L, et al. ACG clinical guideline: gastroparesis. Am J Gastroenterol. 2022;117(8):1197-1220. doi:10.14309/ajg.0000000000001874 [PubMed 35926490]
  29. Cavero-Redondo I, Álvarez-Bueno C, Pozuelo-Carrascosa DP, Díez-Fernández A, Notario-Pacheco B. Risk of extrapyramidal side effects comparing continuous vs. bolus intravenous metoclopramide administration: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs. 2015;24(23-24):3638-3646. doi:10.1111/jocn.12984 [PubMed 26373874]
  30. Cazorla-Ortiz G, Obregón-Guitérrez N, Rozas-Garcia MR, Goberna-Tricas J. Methods and success factors of induced lactation: a scoping review. J Hum Lact. 2020;36(4):739-749. doi:10.1177/0890334420950321 [PubMed 32926655]
  31. Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm [PubMed 6810084]
  32. Cersosimo RJ, Brophy MT. Hiccups with high dose dexamethasone administration: a case report. Cancer. 1998;82(2):412-414. [PubMed 9445200]
  33. Cham S, Basire M, Kelly AM. Intermediate dose metoclopramide is not more effective than standard dose metoclopramide for patients who present to the emergency department with nausea and vomiting: a pilot study. Emerg Med Australas. 2004;16(3):208-211. [PubMed 15228463]
  34. Chang MY, Lin KL, Wang HS, Wu CT. Drug-induced extrapyramidal symptoms at the pediatric emergency department. Pediatr Emerg Care. 2020;36(10):468-472. doi:10.1097/PEC.0000000000001954 [PubMed 31790070]
  35. Chicella MF, Batres LA, Heesters MS, et al, "Prokinetic Drug Therapy in Children: A Review of Current Options," Ann Pharmacother, 2005, 39(4):706-11. [PubMed 15755792]
  36. Childress KMS, Dothager C, Gavard JA, Lebovitz S, Laska C, Mostello DJ. Metoclopramide and diphenhydramine: a randomized controlled trial of a treatment for headache in pregnancy when acetaminophen alone is ineffective (MAD headache study). Am J Perinatol. 2018;35(13):1281-1286. doi:10.1055/s-0038-1646952 [PubMed 29723901]
  37. Chua EW, Harger SP, Kennedy MA. Metoclopramide-induced acute dystonic reactions may be associated with the CYP2D6 poor metabolizer status and pregnancy-related hormonal changes. Front Pharmacol. 2019;10:931. doi:10.3389/fphar.2019.00931 [PubMed 31507424]
  38. Cicek M, Karcioglu O, Parlak I, et al. Prospective, randomised, double blind, controlled comparison of metoclopramide and pethidine in the emergency treatment of acute primary vascular and tension type headache episodes. Emerg Med J. 2004;21(3):323-326. [PubMed 15107371]
  39. Colman I, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials. BMJ. 2004;329(7479):1369-1373. [PubMed 15550401]
  40. Dahl E, Diskin AL. Long-lasting adverse effects after short-term low-dose treatment with metoclopramide for vomiting. Int Marit Health. 2014;65(1):16-19. doi:10.5603/MH.2014.0004 [PubMed 24677122]
  41. Davis M, Hui D, Davies A, et al. MASCC antiemetics in advanced cancer updated guideline. Support Care Cancer. 2021a;29(12):8097-8107. doi:10.1007/s00520-021-06437-w [PubMed 34398289]
  42. Davis M, Hui D, Davies A, et al. Medical management of malignant bowel obstruction in patients with advanced cancer: 2021 MASCC guideline update. Support Care Cancer. 2021b;29(12):8089-8096. doi:10.1007/s00520-021-06438-9 [PubMed 34390398]
  43. De Loose F. Domperidone in chronic dyspepsia: a pilot open study and a multicenter general practice crossover comparison with metoclopramide and placebo. Pharmatherapeutica. 1979;2(3):140-146.
  44. De Oliveira GS Jr, Castro-Alves LJ, Chang R, Yaghmour E, McCarthy RJ. Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii's studies. Br J Anaesth. 2012;109(5):688-697. doi:10.1093/bja/aes325 [PubMed 23015617]
  45. Del Fabbro E. Assessment and management of nausea and vomiting in palliative care. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  46. Del Fabbro E, Hui D, Dalal S, Dev R, Nooruddin ZI, Bruera E. Clinical outcomes and contributors to weight loss in a cancer cachexia clinic [published correction appears in J Palliat Med. 2011;14(12):1361]. J Palliat Med. 2011;14(9):1004-1008. doi: 10.1089/jpm.2011.0098. [PubMed 21793729]
  47. Donthireddy KR, Ailawadhi S, Nasser E, et al. Malignant gastroparesis: pathogenesis and management of an underrecognized disorder. J Support Oncol. 2007;5(8):355-363. [PubMed 17944143]
  48. Egerton-Warburton D, Meek R, Mee MJ, Braitberg G. Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo. Ann Emerg Med. 2014;64(5):526-532.e1. doi: 10.1016/j.annemergmed.2014.03.017. [PubMed 24818542]
  49. Eichenwald EC; Committee on Fetus and Newborn. Diagnosis and management of gastroesophageal reflux in preterm infants. Pediatrics. 2018;142(1):e20181061. [PubMed 29915158]
  50. Ercin D, Erdur B, Turkcuer I, et al. Comparison of efficacy dimenhydrinate and metoclopramide in the treatment of nausea due to vertigo; a randomized study. Am J Emerg Med. 2021;40:77-82. doi:10.1016/j.ajem.2020.12.010 [PubMed 33360021]
  51. Evers S, Afra J, Frese A, et al; European Federation of Neurological Societies. EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968-981. [PubMed 19708964]
  52. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  53. Feinleib J, Kwan LH, Yamani A. Postoperative nausea and vomiting. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  54. Ferrari LR, Donlon JV. Metoclopramide reduces the incidence of vomiting after tonsillectomy in children. Anesth Analg. 1992;75(3):351-354. [PubMed 1510255]
  55. Flank J, Robinson PD, Holdsworth M, et al. Guideline for the treatment of breakthrough and the prevention of refractory chemotherapy-induced nausea and vomiting in children with cancer. Pediatr Blood Cancer. 2016;63(7):1144-1151. [PubMed 26960036]
  56. Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH. Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants. Cochrane Database Syst Rev. 2020;5(5):CD011505. doi:10.1002/14651858.CD011505.pub2 [PubMed 32421208]
  57. Forbes D, Hodgson M, Hill R. The effects of gaviscon and metoclopramide in gastroesophageal reflux in children. J Pediatr Gastroenterol Nutr. 1986;5(4):556-559. [PubMed 3016226]
  58. Ford RG, Ford KT. Continuous intravenous dihydroergotamine in the treatment of intractable headache. Headache. 1997;37(3):129-136. [PubMed 9100396]
  59. Friedman BW, Adewunmi V, Campbell C, et al. A randomized trial of intravenous ketorolac versus intravenous metoclopramide plus diphenhydramine for tension-type and all nonmigraine, noncluster recurrent headaches. Ann Emerg Med. 2013;62(4):311-318.e4. doi: 10.1016/j.annemergmed.2013.03.017. [PubMed 23567060]
  60. Friedman BW, Corbo J, Lipton RB, et al. A trial of metoclopramide vs sumatriptan for the emergency department treatment of migraines. Neurology. 2005;64(3):463-468. doi: 10.1212/01.WNL.0000150904.28131.DD. [PubMed 15699376]
  61. Furman JM, Barton JJS. Treatment of vertigo. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  62. Furyk JS, Meek RA, Egerton-Warburton D. Drugs for the treatment of nausea and vomiting in adults in the emergency department setting. Cochrane Database Syst Rev. 2015;(9):CD010106. doi: 10.1002/14651858.CD010106.pub2. [PubMed 26411330]
  63. Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411-448. [PubMed 32467512]
  64. Gan TJ, Diemunsch P, Habib AS, et al; Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting [published corrections appear in Anesth Analg. 2015;120(2):494; Anesth Analg. 2014;118(3):689]. Anesth Analg. 2014;118(1):85-113. doi: 10.1213/ANE.0000000000000002. [PubMed 24356162]
  65. Garza I, Schwedt TJ. Medication overuse headache: Treatment and prognosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  66. Gimoti (metoclopramide) [prescribing information]. Solana Beach, CA: Evoke Pharma Inc; January 2021.
  67. Glare PA, Dunwoodie D, Clark K, et al. Treatment of nausea and vomiting in terminally ill cancer patients. Drugs. 2008;68(18):2575-2590. doi: 10.2165/0003495-200868180-00004. [PubMed 19093700]
  68. Glare P, Miller J, Nikolova T, Tickoo R. Treating nausea and vomiting in palliative care: a review. Clin Interv Aging. 2011;6:243-259. doi: 10.2147/CIA.S13109. [PubMed 21966219]
  69. Gora ML, Visconti JA, Seth S, Shields B, Bay W. Pharmacokinetics of intraperitoneal metoclopramide in a patient with renal failure. Clin Pharm. 1992;11(2):174-176. [PubMed 1551299]
  70. Gupta M, Davis M, LeGrand S, Walsh D, Lagman R. Nausea and vomiting in advanced cancer: the Cleveland Clinic protocol. J Support Oncol. 2013;11(1):8-13. [PubMed 23137588]
  71. Hagberg CA, Artime C. Flexible scope intubation for anesthesia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  72. Hamilton KT, Robbins MS. Migraine treatment in pregnant women presenting to acute care: a retrospective observational study. Headache. 2019;59(2):173-179. doi:10.1111/head.13434 [PubMed 30403400]
  73. Hansen WF, McAndrew S, Harris K, Zimmerman MB. Metoclopramide effect on breastfeeding the preterm infant: a randomized trial. Obstet Gynecol. 2005;105(2):383-389. doi:10.1097/01.AOG.0000151113.33698.a8 [PubMed 15684169]
  74. Henzi I, Walder B, Tramèr MR. Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. Br J Anaesth. 1999;83(5):761-771. [PubMed 10690140]
  75. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008;358(23):2482-2494. [PubMed 18525044]
  76. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO guideline update. J Clin Oncol. 2020;38(24):2782-2797. doi:10.1200/JCO.20.01296 [PubMed 32658626]
  77. Hesketh PJ. Prevention of chemotherapy-induced nausea and vomiting in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  78. Hu B, Ouyang X, Lei L, et al. Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial. Intensive Care Med. 2018;44(12):2174-2182. doi:10.1007/s00134-018-5466-4 [PubMed 30465070]
  79. Igata R, Hori H, Atake K, Katsuki A, Nakamura J. Adding metoclopramide to paroxetine induced extrapyramidal symptoms and hyperprolactinemia in a depressed woman: a case report. Neuropsychiatr Dis Treat. 2016;12:2279-2281. doi:10.2147/NDT.S116686 [PubMed 27621638]
  80. "Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  81. Ishikawa T, Obara T, Akazawa M, et al. Risk of major congenital malformations associated with first-trimester exposure to propulsives: a health administrative database study in Japan. Pharmacoepidemiol Drug Saf. 2022;31(2):196-205. doi:10.1002/pds.5370 [PubMed 34628689]
  82. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. doi:10.1056/NEJM200007133430208 [PubMed 10891521]
  83. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al; American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1383-1391, 1391.e1-5. doi: 10.1053/j.gastro.2008.08.045. [PubMed 18789939]
  84. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease [published correction appears in Am J Gastroenterol. 2013;108(10):1672]. Am J Gastroenterol. 2013;108(3):308-328. doi: 10.1038/ajg.2012.444. [PubMed 23419381]
  85. Kauppila A, Arvela P, Koivisto M, Kivinen S, Ylikorkala O, Pelkonen O. Metoclopramide and breast feeding: transfer into milk and the newborn. Eur J Clin Pharmacol. 1983;25(6):819-823. doi: 10.1007/BF00542527 [PubMed 6662181]
  86. Kearns GL, Butler HL, Lane JK, Carchman SH, Wright GJ. Metoclopramide pharmacokinetics and pharmacodynamics in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 1988;7(6):823-829. [PubMed 3199269]
  87. Kearns GL, van den Anker JN, Reed MD, et al, "Pharmacokinetics of Metoclopramide in Neonates," J Clin Pharmacol, 1998, 38(2):122-8. [PubMed 9549642]
  88. Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 2: neuroleptics, antihistamines, and others. Headache. 2012;52(2):292-306. doi:10.1111/j.1526-4610.2011.02070.x [PubMed 22309235]
  89. Kelly D, Moran C, Maher M, O'Mahony S. Malignancy-associated gastroparesis: an important and overlooked cause of chronic nausea and vomiting [published online February 10, 2014]. BMJ Case Rep. doi: 10.1136/bcr-2013-201815. [PubMed 24515229]
  90. Kimball AL, Carlton DP. Gastroesophageal reflux medications in the treatment of apnea in premature infants. J Pediatr. 2001;138(3):355-360. [PubMed 11241042]
  91. Lehmann CR, Heironimus JD, Collins CB, et al. Metoclopramide kinetics in patients with impaired renal function and clearance by hemodialysis. Clin Pharmacol Ther. 1985;37(3):284-289. doi:10.1038/clpt.1985.41 [PubMed 3971652]
  92. Lembo AJ. Hiccups. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  93. Leonard JB, Munir KM, Kim HK. Metoclopramide induced pheochromocytoma crisis. Am J Emerg Med. 2018;36(6):1124.e1-1124.e2. doi:10.1016/j.ajem.2018.03.009 [PubMed 29534916]
  94. Leung J, Silverman W. Diagnostic and therapeutic approach to pancreatic cancer-associated gastroparesis: literature review and our experience. Dig Dis Sci. 2009;54(2):401-405. doi: 10.1007/s10620-008-0354-3. [PubMed 18618259]
  95. Levichek Z, Atanackovic G, Oepkes D, et al. Nausea and vomiting of pregnancy. Evidence-based treatment algorithm. Can Fam Physician. 2002;48:267-268, 277. [PubMed 11889884]
  96. Lewis PJ, Devenish C, Kahn C. Controlled trial of metoclopramide in the initiation of breast feeding. Br J Clin Pharmacol. 1980;9(2):217-219. doi:10.1111/j.1365-2125.1980.tb05838.x [PubMed 6986894]
  97. Lin DM, Furst SR, Rodarte A. A double-blinded comparison of metoclopramide and droperidol for prevention of emesis following strabismus surgery. Anesthesiology. 1992;76(3):357-361. [PubMed 1539845]
  98. Longstreth GF. Approach to the adult with nausea and vomiting. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023a.
  99. Longstreth GF. Functional dyspepsia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023b.
  100. Lovas A, Almos PZ, Peto Z, Must A, Horváth S. Anesthesia for electroconvulsive therapy in early pregnancy. J ECT. 2011;27(4):328-330. doi: 10.1097/YCT.0b013e318213cd00. [PubMed 21673588]
  101. Madanagopolan N. Metoclopramide in hiccup. Curr Med Res Opin. 1975;3(6):371-374. [PubMed 1183218]
  102. Madani S, Tolia V. Gynecomastia with metoclopramide use in pediatric patients. J Clin Gastroenterol. 1997;24(2):79-81. doi:10.1097/00004836-199703000-00006 [PubMed 9077721]
  103. Malkoff MD, Ponzillo JJ, Myles GL, Gomez CR, Cruz-Flores S. Sinus arrest after administration of intravenous metoclopramide. Ann Pharmacother. 1995;29(4):381-383. [PubMed 7633016]
  104. Manchikanti L, Marrero TC, Roush JR. Preanesthetic cimetidine and metoclopramide for acid aspiration prophylaxis in elective surgery. Anesthesiology. 1984;61(1):48-54. [PubMed 6377973]
  105. Manoharan A. Metoclopramide-induced agranulocytosis. Med J Aust. 1988;149(9):508. doi:10.5694/j.1326-5377.1988.tb120746.x [PubMed 3185349]
  106. Marshall G, Kerr S, Vowels M, O'Gorman-Hughes D, White L. Antiemetic therapy for chemotherapy-induced vomiting: metoclopramide, benztropine, dexamethasone, and lorazepam regimen compared with chlorpromazine alone. J Pediatr. 1989;115(1):156-160. [PubMed 2661789]
  107. Matok I, Gorodischer R, Koren G, et al, “The Safety of Metoclopramide Use in the First Trimester of Pregnancy,” N Engl J Med, 2009, 360(24):2528-35. [PubMed 19516033]
  108. McCallum RW, Valenzuela G, Polepalle S, Spyker D. Subcutaneous metoclopramide in the treatment of symptomatic gastroparesis: clinical efficacy and pharmacokinetics. J Pharmacol Exp Ther. 1991;258(1):136-142. [PubMed 2072291]
  109. McCammon RL. Prophylaxis for aspiration pneumonitis. Can Anaesth Soc J. 1986;33(3, pt 2):S47-S53. [PubMed 2872952]
  110. Mehler P. Anorexia nervosa in adults and adolescents: Medical complications and their management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  111. Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273-288. doi:10.1210/jc.2010-1692 [PubMed 21296991]
  112. Menon P, Thunga G, Nambiar S, Khera K. Atypical presentation of metoclopramide-induced galactorrhea. Journal of Pharmacy Practice and Research. 2015;45(4):427-429.
  113. Metoclopramide. Drugs and Lactation Database (LactMed). National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK501352/. Updated February 15, 2021. Accessed February 2021.
  114. Metoclopramide injection [product monograph]. Boucherville, QC, Canada: Sandoz Canada Inc; November 2014.
  115. Metoclopramide injection [prescribing information]. East Brunswick, NJ: Heritage Pharmaceuticals Inc; June 2018.
  116. Metoclopramide injection [prescribing information]. North Wales, PA: Teva Pharmaceuticals USA Inc; April 2018.
  117. Metoclopramide injection (pre-filled syringe) [prescribing information]. Lake Zurich, IL: Hospira, Inc; December 2022.
  118. Metoclopramide injection [summary of product characteristics]. Gloucester, United Kingdom: Hameln Pharmaceuticals Ltd; January 2020.
  119. Metoclopramide injection solution [prescribing information]. Lake Fores, IL: Hospira; December 2022.
  120. Metoclopramide oral solution, USP [prescribing information]. Greenville, SC: Pharmaceutical Associates Inc; March 2023.
  121. Metoclopramide orally disintegrating tablets [prescribing information]. Somerset, NJ: Novel Laboratories Inc; December 2020.
  122. Metoclopramide tablets [prescribing information]. Columbus, OH: American Health Packaging; August 2022.
  123. Metonia (metoclopramide) [product monograph]. Montreal, Quebec, Canada: Pendopharm; March 2020.
  124. Metozolv ODT (metoclopramide) [prescribing information]. Bridgewater, NJ: Salix Pharmaceuticals, Inc; February 2019.
  125. Meyers RS, Thackray J, Matson KL, et al. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr Pharmacol Ther. 2020;25(3):175-191. [PubMed 32265601]
  126. Middleton RS. The use of metoclopramide in the elderly. Postgrad Med J. 1973;49(suppl 4):90-94. [PubMed 4804475]
  127. Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. doi: 10.1038/ajg.2017.154. [PubMed 28631728]
  128. Mussavi M, Asadollahi K, Abangah G. Effects of metoclopramide on feeding intolerance among preterm neonates; a randomized controlled trial. Iran J Pediatr. 2014;24(5):630-636. [PubMed 25793073]
  129. Nguyen TT, Petzel Gimbar RM. Sustained hypotension following intravenous metoclopramide. Ann Pharmacother. 2013;47(11):1577-1580. doi:10.1177/1060028013503789 [PubMed 24259597]
  130. Nixon H, Leffert L. Anesthesia for cesarean delivery. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  131. O'Reardon JP, Cristancho MA, von Andreae CV, Cristancho P, Weiss D. Acute and maintenance electroconvulsive therapy for treatment of severe major depression during the second and third trimesters of pregnancy with infant follow-up to 18 months: case report and review of the literature. J ECT. 2011;27(1):e23-e26. doi: 10.1097/YCT.0b013e3181e63160. [PubMed 20562638]
  132. Olsson GL, Hallén B. Pharmacological evacuation of the stomach with metoclopramide. Acta Anaesthesiol Scand. 1982;26(5):417-420. [PubMed 7148360]
  133. Orr DA, Bill KM, Gillon KR, Wilson CM, Fogarty DJ, Moore J. Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia. Anaesthesia. 1993;48(2):114-119. [PubMed 8460756]
  134. Orr SL, Friedman BW, Christie S, et al. Management of adults with acute migraine in the emergency department: the American Headache Society evidence assessment of parenteral pharmacotherapies. Headache. 2016;56(6):911-940. doi: 10.1111/head.12835. [PubMed 27300483]
  135. Ouyang X, Qu R, Hu B, et al. Is metoclopramide beneficial for the postpyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials. Nutr Clin Pract. 2022;37(2):316-327. doi:10.1002/ncp.10725 [PubMed 34155678]
  136. Parlak I, Atilla R, Cicek M, et al. Rate of metoclopramide infusion affects the severity and incidence of akathisia. Emerg Med J. 2005;22(9):621-624. doi:10.1136/emj.2004.014712 [PubMed 16113179]
  137. Patel P, Robinson PD, Thackray J, et al. Guideline for the prevention of acute chemotherapy-induced nausea and vomiting in pediatric cancer patients: A focused update. Pediatr Blood Cancer. 2017;64(10):10.1002/pbc.26542. [PubMed 28453189]
  138. Pietrzko P, Zakrzewski A, Matuszewski T, Kruszewski J. Angioneurotic edema: a rare case of hypersensitivity to metoclopramide. Postepy Dermatol Alergol. 2013;30(2):117-118. doi:10.5114/pdia.2013.34163 [PubMed 24278059]
  139. pms-Metoclopramide hydrochloride injection [product monograph]. Montreal, Quebec, Canada: Pharmascience Inc; May 2022.
  140. Pringsheim T, Davenport WJ, Marmura MJ, Schwedt TJ, Silberstein S. How to apply the AHS evidence assessment of the acute treatment of migraine in adults to your patient with migraine. Headache. 2016;56(7):1194-1200. doi:10.1111/head.12870 [PubMed 27322907]
  141. Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand. 2002;46(1):109-113. [PubMed 11903083]
  142. Qiu LM, Lim BL. Case of acute akathisia from intravenous metoclopramide. Singapore Med J. 2011;52(1):e12-e14. [PubMed 21298228]
  143. Rabheru K. The use of electroconvulsive therapy in special patient populations. Can J Psychiatry. 2001;46(8):710-719. [PubMed 11692973]
  144. Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther. 2010;31(1):11-19. doi:10.1111/j.1365-2036.2009.04189.x [PubMed 19886950]
  145. Raskin NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology. 1986;36(7):995-997. [PubMed 3520384]
  146. Refer to manufacturer’s labeling.
  147. Reglan (metoclopramide) [prescribing information]. Baudette, MN: ANI Pharmaceuticals; August 2017.
  148. Ripamonti C, Bruera E. Palliative management of malignant bowel obstruction. Int J Gynecol Cancer. 2002;12(2):135-143. [PubMed 11975672]
  149. Rocke DA, Rout CC, Gouws E. Intravenous administration of the proton pump inhibitor omeprazole reduces the risk of acid aspiration at emergency cesarean section. Anesth Analg. 1994;78(6):1093-1098. [PubMed 8198263]
  150. Rode H, Stunden RJ, Millar AJ, Cywes S. Esophageal pH assessment of gastroesophageal reflux in 18 patients and the effect of two prokinetic agents: cisapride and metoclopramide. J Pediatr Surg. 1987;22(10):931-934. [PubMed 3681625]
  151. Roila F, Aapro M, Stewart A. Optimal selection of antiemetics in children receiving cancer chemotherapy. Support Care Cancer. 1998;6(3):215-220. [PubMed 9629872]
  152. Roila F, Feyer P, Maranzano E, Olver I, Clark-Snow R, Warr D, Molassiotis A. Antiemetics in children receiving chemotherapy. Support Care Cancer. 2005;13(2):129-131. [PubMed 15538642]
  153. Roila F, Herrstedt J, Aapro M, et al; ESMO/MASCC Guidelines Working Group. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol. 2010;21(suppl 5):v232-v243. [PubMed 20555089]
  154. Roila F, Molassiotis A, Herrstedt J, et al; participants of the MASCC/ESMO Consensus Conference Copenhagen 2015. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016;27(suppl 5):v119-v133. doi: 10.1093/annonc/mdw270. [PubMed 27664248]
  155. Roila F, Ruggeri B, Ballatori E, et al; Italian Group for Antiemetic Research. Aprepitant versus metoclopramide, both combined with dexamethasone, for the prevention of cisplatin-induced delayed emesis: a randomized, double-blind study. Ann Oncol. 2015;26(6):1248-1253. doi: 10.1093/annonc/mdv132. [PubMed 25743855]
  156. Rose JB, Martin TM. Posttonsillectomy vomiting. Ondansetron or metoclopramide during paediatric tonsillectomy: are two doses better than one?. Paediatr Anaesth. 1996;6(1):39-44. [PubMed 8839087]
  157. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. [PubMed 29470322]
  158. Sakha K, Behbahan AG. Training for perfect breastfeeding or metoclopramide: which one can promote lactation in nursing mothers? Breastfeed Med. 2008;3(2):120-123. doi: 10.1089/bfm.2007.0020. [PubMed 18564001]
  159. Sankaran K, Yeboah E, Bingham WT, Ninan A. Use of metoclopramide in preterm infants. Dev Pharmacol Ther. 1982;5(3-4):114-119. [PubMed 7151642]
  160. Schwedt TJ, Garza Ivan. Acute treatment of migraine in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  161. Seema, Patwari AK, Satyanarayana L. Relactation: an effective intervention to promote exclusive breastfeeding. J Trop Pediatr. 1997;43(4):213-216. doi: 10.1093/tropej/43.4.213. [PubMed 9283123]
  162. Sethi KD, Patel B, Meador KJ. Metoclopramide-induced parkinsonism. South Med J. 1989;82(12):1581-1582. doi:10.1097/00007611-198912000-00033 [PubMed 2595431]
  163. Shen Q, Khan KS, Du MC, Du WW, Ouyang YQ. Efficacy and safety of domperidone and metoclopramide in breastfeeding: a systematic review and meta-analysis. Breastfeed Med. 2021;16(7):516-529. doi:10.1089/bfm.2020.0360 [PubMed 33769844]
  164. Shende D, Mandal NG. Efficacy of ondansetron and metoclopramide for preventing postoperative emesis following strabismus surgery in children. Anaesthesia. 1997;52(5):496-500. [PubMed 9165973]
  165. Shivshanker K, Bennett RW Jr, Haynie TP. Tumor-associated gastroparesis: correction with metoclopramide. Am J Surg. 1983;145(2):221-225. [PubMed 6824135]
  166. Silberstein SD, Schulman EA, Hopkins MM. Repetitive intravenous DHE in the treatment of refractory headache. Headache. 1990;30(6):334-339. [PubMed 2370132]
  167. Silberstein SD, Silberstein JR. Chronic daily headache: long-term prognosis following inpatient treatment with repetitive IV DHE. Headache. 1992;32(9):439-445. [PubMed 1446987]
  168. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology [published correction appears in Neurology. 2000;56(1):142]. Neurology. 2000;55(6):754-762. [PubMed 10993991]
  169. Silva CC, Bennett C, Saconato H, Atallah ÁN. Metoclopramide for post-pyloric placement of naso-enteral feeding tubes. Cochrane Database Syst Rev. 2015;1:CD003353. doi: 10.1002/14651858.CD003353.pub2. [PubMed 25564770]
  170. Smith I, Kranke P, Murat I, et al. European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28(8):556-569. [PubMed 21712716]
  171. Smith JA, Fox Ka, Clark S. Nausea and vomiting of pregnancy: Treatment and outcome. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023.
  172. Sørensen HT, Nielsen GL, Christensen K, et al. Birth outcome following maternal use of metoclopramide. The Euromap study group. Br J Clin Pharmacol. 2000;49(3):264-268. [PubMed 10718782]
  173. Stene FN, Seay RE, Young LA, Bohnsack LE, Bostrom BC. Prospective, randomized, double-blind, placebo-controlled comparison of metoclopramide and ondansetron for prevention of posttonsillectomy or adenotonsillectomy emesis. J Clin Anesth. 1996;8(7):540-544. [PubMed 8910174]
  174. Stuart JC, Kan AF, Rowbottom SJ, Yau G, Gin T. Acid aspiration prophylaxis for emergency Caesarean section. Anaesthesia. 1996;51(5):415-421. [PubMed 8694150]
  175. Sun L, Xi Y, Wen X, Zou W. Use of metoclopramide in the first trimester and risk of major congenital malformations: a systematic review and meta-analysis. PLoS One. 2021;16(9):e0257584. doi:10.1371/journal.pone.0257584 [PubMed 34543335]
  176. Surawski RJ, Quinn DK. Metoclopramide and homicidal ideation: a case report and literature review. Psychosomatics. 2011;52(5):403-409. doi:10.1016/j.psym.2011.02.001 [PubMed 21907057]
  177. Svendsen K, Wood M, Olsson E, Nordeng H. Reported time to onset of neurological adverse drug reactions among different age and gender groups using metoclopramide: an analysis of the global database Vigibase®. Eur J Clin Pharmacol. 2018;74(5):627-636. doi:10.1007/s00228-017-2407-z [PubMed 29290074]
  178. Swartz R, Longwell P. Treatment of vertigo. Am Fam Physician. 2005;71(6):1115-1122. [PubMed 15791890]
  179. Tan PC, Khine PP, Vallikkannu N, Omar SZ. Promethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol. 2010;115(5):975-981. doi: 10.1097/AOG.0b013e3181d99290. [PubMed 20410771]
  180. Terrin BN, McWilliams NB, Maurer HM. Side effects of metoclopramide as an antiemetic in childhood cancer chemotherapy. J Pediatr. 1984;104(1):138-140. [PubMed 6690659]
  181. Tolia V, Calhoun J, Kuhns L, Kauffman RE. Randomized, prospective double-blind trial of metoclopramide and placebo for gastroesophageal reflux in infants. J Pediatr. 1989;115(1):141-145. [PubMed 2661788]
  182. Tramèr M, Moore A, McQuay H. Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat method. Br J Anaesth. 1995;75(5):556-561. [PubMed 7577280]
  183. Tsai SC, Sheu SY, Chien LN, Lee HC, Yuan EJ, Yuan RY. High exposure compared with standard exposure to metoclopramide associated with a higher risk of parkinsonism: a nationwide population-based cohort study. Br J Clin Pharmacol. 2018;84(9):2000-2009. doi:10.1111/bcp.13630 [PubMed 29745438]
  184. Tura P, Erdur B, Aydin B, Turkcuer I, Parlak I. Slow infusion metoclopramide does not affect the improvement rate of nausea while reducing akathisia and sedation incidence. Emerg Med J. 2012;29(2):108-112. doi:10.1136/emj.2010.094367 [PubMed 21292793]
  185. Twycross R, Wilcock A, Howard P, eds. Palliative Care Formulary. 6th ed. London, United Kingdom: Palliativedrugs.com Ltd; 2017:240-245.
  186. Van Gool AR, Doorduijn JK, Seynaeve C. Severe akathisia as a side effect of metoclopramide. Pharm World Sci. 2010;32(6):704-706. doi:10.1007/s11096-010-9444-3 [PubMed 21052838]
  187. Van Veldhuizen PJ, Wyatt A. Metoclopramide-induced sulfhemoglobinemia. Am J Gastroenterol. 1995;90(6):1010-1011. [PubMed 7771397]
  188. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498-547. [PubMed 19745761]
  189. Wallenborn J, Gelbrich G, Bulst D, et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial. BMJ. 2006;333(7563):324. doi:10.1136/bmj.38903.419549.80 [PubMed 16861255]
  190. Wang T, Wang D. Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study. Intern Med J. 2014;44(12a):1205-1209. [PubMed 25069531]
  191. Weibel S, Schaefer MS, Raj D, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: an abridged Cochrane network meta-analysis. Anaesthesia. 2021;76(7):962-973. doi:10.1111/anae.15295 [PubMed 33170514]
  192. Wittmann O, Sadot E, Bisker-Kassif O, Scolnik D, Tavor O, Glatstein MM. Neuroleptic malignant syndrome associated with metoclopramide use in a boy: Case report and review of the literature. Am J Ther. 2016;23(5):e1246-e1249. doi:10.1097/MJT.0000000000000320 [PubMed 26241559]
  193. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. 2002. Available at https://apps.who.int/iris/handle/10665/62435.
  194. Wright MR, Axelson JE, Rurak DW, et al. Effect of haemodialysis on metoclopramide kinetics in patients with severe renal failure. Br J Clin Pharmacol. 1988;26(4):474-477. doi:10.1111/j.1365-2125.1988.tb03408.x [PubMed 3190998]
  195. Yis U, Ozdemir D, Duman M, Unal N. Metoclopramide induced dystonia in children: two case reports. Eur J Emerg Med. 2005;12(3):117-119. [PubMed 15891443]
  196. Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C. Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci. 2010;13(2):162-174. [PubMed 20816003]
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