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Metoclopramide
⚠️ Key Safety Notes: - Most common cause of drug-induced acute dystonia. - Avoid in patients <21 years (especially young females). - Contraindicated in bowel obstruction and Parkinson’s disease. - Restricted in the UK/EU to max 5 days use due to neurological risks.
📖 About
Always check the BNF link here.
- 💊 Dopamine antagonist anti-emetic with pro-kinetic action.
- ⚠️ Risk of acute dystonic reactions, especially in the young.
- Short-term use only (≤5 days) for nausea and vomiting.
⚡ Mechanism of Action
- ⛔ Central D2 receptor blockade in the chemoreceptor trigger zone (CTZ).
- ⬆️ Increases gastric emptying and enhances gut motility.
- ⬇️ Reduces nausea and vomiting by blocking dopaminergic input to the vomiting centre.
🩺 Indications
- 🤢 Nausea and vomiting (post-op, chemotherapy, palliative care).
- 🧠 Migraine (with analgesics, short-term use only).
- ⚡ Gastroparesis or delayed gastric emptying (limited role, short-term).
- 🏥 As an adjunct with opioids to reduce opioid-induced gastric stasis.
💊 Dosing – Metoclopramide (verify in BNF/datasheet)
| Drug / Indication | Details |
|---|---|
| 💊 Metoclopramide |
• Dose: 10 mg
• Frequency: Up to TDS (every 8 h PRN) • Route: PO / IV / IM |
- 📌 Maximum course: 5 days (safety restriction).
- 💉 IV: give slowly over ≥3 minutes (rapid injection ↑ risk of dystonia/arrhythmia).
- ⚖️ Reduce dose in renal impairment and elderly.
🚫 Contraindications
- Age <21 years (high risk of dystonia, esp. females).
- Bowel obstruction or perforation.
- Parkinson’s disease (worsens motor symptoms).
- Phaeochromocytoma (can trigger hypertensive crisis).
- Epilepsy (lowers seizure threshold).
- History of neuroleptic malignant syndrome (NMS).
🔄 Interactions
- ⬇️ Antagonises levodopa and dopamine agonists (worsens Parkinson’s symptoms).
- ⬆️ CNS depression with opioids, alcohol, benzodiazepines.
- May ↑ ciclosp
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