Metoclopramide Hydrochloride
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Generic Name of Metoclopramide Hydrochloride - Learn More
Metoclopramide Hydrochloride
Metoclopramide Hydrochloride Precaution - What You Need to Know
Before using Metoclopramide Hydrochloride, patients must consult their healthcare provider to ensure it is appropriate for their condition. Important precautions include:
- Gastrointestinal conditions: Metoclopramide can cause increased gastric motility, so it should be used cautiously in patients with gastrointestinal bleeding, obstruction, or perforation, as these conditions could be worsened.
- Movement disorders: Metoclopramide may cause extrapyramidal symptoms (EPS), including tardive dyskinesia (involuntary, repetitive movements). This is particularly true with long-term use, so the drug should be used for the shortest duration possible to avoid the development of these disorders. Patients with a history of Parkinson's disease or other movement disorders should be cautious, as symptoms may worsen.
- Renal impairment: In patients with renal insufficiency, dose adjustments may be necessary, as the drug is eliminated by the kidneys. Close monitoring of kidney function is essential.
- Mental health: Metoclopramide can cause sedation, drowsiness, or mental confusion, especially in elderly patients. It should be used cautiously in patients with depression or other psychiatric conditions.
- Pregnancy: Metoclopramide should only be used during pregnancy if the benefits outweigh the risks. It is considered Category B, meaning animal studies have not shown harm, but there is limited human data available.
Metoclopramide Hydrochloride Indication - Uses and Benefits
Metoclopramide is commonly prescribed for several medical conditions, primarily related to the gastrointestinal tract:
- Gastroesophageal reflux disease (GERD): It is used to treat GERD, where it helps to increase gastric motility and reduce acid reflux.
- Nausea and vomiting: Metoclopramide is effective in managing nausea and vomiting, especially those caused by chemotherapy or radiation treatment, or following surgery.
- Gastroparesis: It is indicated for gastroparesis (delayed stomach emptying), particularly in patients with diabetes, where it helps improve gastric motility and alleviates symptoms like nausea, bloating, and early satiety.
- Postoperative nausea: It is used to prevent and treat nausea and vomiting following surgery.
- Diagnostic procedures: Metoclopramide may be used before certain diagnostic procedures to help with the emptying of the stomach or preparation for gastrointestinal imaging.
Metoclopramide Hydrochloride Contraindications - Important Warnings
Metoclopramide should be avoided in the following situations:
- History of hypersensitivity: Patients with a known allergy or hypersensitivity to metoclopramide should not take the medication, as it may cause severe allergic reactions, including rash, itching, or difficulty breathing.
- Pheochromocytoma: Metoclopramide is contraindicated in patients with pheochromocytoma (a rare tumor of the adrenal glands), as it may precipitate a hypertensive crisis.
- Gastrointestinal obstruction: It should not be used in patients with bowel obstruction, as it may worsen the condition by increasing gastric motility.
- History of tardive dyskinesia: Patients who have previously experienced tardive dyskinesia or other extrapyramidal symptoms from antipsychotic drugs or similar medications should not use metoclopramide.
- Severe renal impairment: In patients with severe renal dysfunction, dose adjustments are required, and metoclopramide may be contraindicated depending on the severity of renal failure.
Metoclopramide Hydrochloride Side Effects - What to Expect
Common side effects of Metoclopramide Hydrochloride include:
- Extrapyramidal symptoms (EPS): These include tremors, muscle rigidity, and dystonia (involuntary muscle contractions), particularly with prolonged use or higher doses.
- Drowsiness: Metoclopramide can cause sedation and dizziness, especially when first starting the medication or when combined with other CNS depressants.
- Tardive dyskinesia: A serious, often irreversible condition involving involuntary and repetitive movements, typically seen with long-term use. It may be exacerbated by high doses.
- Diarrhea: Some patients may experience diarrhea or abdominal cramping as a result of increased gastric motility.
- Fatigue: Patients may feel tired or weak during treatment.
- Mental health effects: Depression, irritability, or anxiety can occur in some patients.
- Hyperprolactinemia: Increased levels of prolactin may lead to galactorrhea (milk production) or amenorrhea (absence of menstruation).
- Allergic reactions: Rarely, patients may experience severe allergic reactions, including rash, hives, or difficulty breathing.
Metoclopramide Hydrochloride Pregnancy Category ID - Safety Information
2
Metoclopramide Hydrochloride Mode of Action - How It Works
Metoclopramide works by increasing gastrointestinal motility and facilitating gastric emptying. Its primary mechanism of action includes:
- Dopamine antagonism: Metoclopramide blocks dopamine receptors (particularly D2 receptors) in the gastrointestinal tract and the central nervous system. This action increases the release of acetylcholine, which stimulates smooth muscle contractions in the stomach and intestines, promoting gastric emptying.
- Central nervous system effects: In the brain, metoclopramide affects the dopamine receptors in the medulla, which controls vomiting. By blocking these receptors, it reduces nausea and vomiting.
- Prokinetic effect: Metoclopramide enhances the tone and motility of the upper gastrointestinal tract, facilitating faster movement of food from the stomach into the intestines and reducing symptoms of gastroparesis.
Metoclopramide Hydrochloride Drug Interactions - What to Avoid
Metoclopramide can interact with several drugs and substances, potentially altering its efficacy or safety:
- Antipsychotics: Antipsychotic medications (e.g., haloperidol, chlorpromazine) may increase the risk of extrapyramidal side effects (such as tardive dyskinesia) when taken with metoclopramide.
- CNS depressants: Combining metoclopramide with sedatives, alcohol, benzodiazepines, or opioids may enhance the sedative effects, causing drowsiness, respiratory depression, or impaired coordination.
- Digoxin: Metoclopramide may reduce the absorption of digoxin, a medication used for heart failure and arrhythmias, potentially decreasing its effectiveness.
- Cyclosporine: Metoclopramide can affect the absorption of cyclosporine, potentially reducing its levels and affecting the immune response in transplant patients.
- Levodopa: Since levodopa is used to treat Parkinson's disease, combining it with metoclopramide can worsen Parkinsonian symptoms due to the risk of worsening extrapyramidal symptoms.
- Anticoagulants: Caution is required when combining metoclopramide with anticoagulants (e.g., warfarin) as it may increase the risk of bleeding.
Metoclopramide Hydrochloride Adult Dose - Recommended Dosage
The typical adult dose of Metoclopramide Hydrochloride for various indications includes:
- For nausea/vomiting (including chemotherapy-induced nausea): The usual dose is 10 mg to 15 mg taken 3 to 4 times daily before meals and at bedtime.
- For GERD: A dose of 10 mg to 15 mg 3 to 4 times daily, typically 30 minutes before meals.
- For gastroparesis: 10 mg to 15 mg taken 3 to 4 times a day, ideally 30 minutes before meals.
- Postoperative nausea: A dose of 10 mg is typically administered as a single dose, with further dosing if needed.
- The maximum dose should generally not exceed 60 mg per day.
Metoclopramide Hydrochloride Child Dose - Dosage for Children
For pediatric patients, metoclopramide is commonly used for nausea and vomiting:
- Children (aged 6 to 14 years): The typical dose is 0.1 to 0.15 mg/kg of body weight, administered up to 3 times daily.
- The maximum dose should not exceed 5 mg per dose.
- Infants (aged 1 to 5 years): The dose may start at 0.1 mg/kg every 6 to 8 hours, with monitoring for side effects.
Metoclopramide Hydrochloride Renal Dose - Dosage for Kidney Conditions
Patients with renal impairment may require dose adjustments:
- Mild to moderate renal impairment (CrCl 40–60 mL/min): The usual dose may be reduced by 50%.
- Severe renal impairment (CrCl < 40 mL/min): Metoclopramide should be used cautiously, with dosing adjustments and more frequent monitoring for side effects. A lower starting dose is recommended.
- End-stage renal disease: Patients undergoing dialysis may require significantly reduced doses, and the drug should be used with caution.
