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Overview

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This medicine contains an important and useful components, as it consists of
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Name

Metoclopramide Hydrochloride

Precaution

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.

Indication

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.

Contra indication

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.

Side Effect

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**.

Pregnancy Category ID

2

Mode of Action

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**.

Interaction

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**.

Pregnancy Category Note

Information not available

Adult Dose

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**.

Child Dose

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.

Renal Dose

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.

Administration

Information not available