Metoclopramide

Metoclopramide - acts by promoting gastric emptying, increasing gut motility and has an anti-emetic effect. It raises the threshold of the chemoreceptor trigger zone. In high doses it has 5-HT3 antagonist action.

Uses
Anti-emetic
Promotes gastric emptying
Increases lower oesophageal sphincter tone

Administration
• IV/IM/PO/NG: 10 mg 8 hourly

How not to use metoclopramide
Orally not appropriate if actively vomiting
Rapid IV bolus (hypotension)

Adverse effects
Extrapyramidal movements
Neuroleptic malignant syndrome

Cautions
Increased risk of extrapyramidal side-effects occurs in the following:
• hepatic and renal impairment
• children, young adults (especially girls) and the very old
• concurrent use of anti-psychotics
• concurrent use of lithium

Treatment of acute oculogyric crises includes stopping metoclopramide (usually subside within 24 hours) or giving procyclidine
5–10 mg IV (usually effective within 5 min)

Organ failure
Hepatic: reduce dose
Renal: reduce dose

Renal replacement therapy
No further dose modification is required during renal replacement therapy