Metoclopramide (Injection, Intravenous)

Overview

Although nausea and vomiting can occur as a result of relatively minor illnesses, it can also be caused by long-term conditions and other treatments. If patients are undergoing chemotherapy as part of a cancer treatment, for example, they can experience severe nausea and vomiting as a side effect of their medication. Metoclopramide can be used to relieve these symptoms and to prevent patients from losing weight due to ongoing nausea and vomiting.

Similarly, patients can experience nausea and vomiting due to a variety of other factors, such as infections, uremia, radiation treatment and/or the use of emetogenic drugs. By administering Metoclopramide, physicians can reduce the patient's symptoms. Although Metoclopramide isn't a first-line treatment for hyperemesis gravidarum, it can be used to treat severe nausea and vomiting during pregnancy if other treatments have failed.

Furthermore, Metoclopramide can be an appropriate treatment for delayed gastric emptying and is of particular use in treating gastroparesis in diabetic patients. When gastroparesis occurs, the patient's stomach does not empty as efficiently as it should. This can cause symptoms including nausea and vomiting, as well as a feeling of fullness, loss of appetite and heartburn. As Metoclopramide increases contractions within the intestines and stomach, it can increase the speed at which the stomach empties and, therefore, relieve the patient's symptoms.

When administered, Metoclopramide acts as an antagonist at dopamine D2 receptors in the chemoreceptor trigger zone of the central nervous system. As a result, nausea and vomiting are reduced in most situations, regardless of the stimuli.

In addition to this, Metoclopramide increases gastric contractions and regulates the movements of the jejunum and duodenum, as well as relaxing the duodenal bulb and the pyloric sphincter. This increases the emptying of the stomach, meaning that the medication can be used to treat gastroparesis and can also be beneficial when patients are undergoing certain medical tests, such as radiographical studies.

Whilst Metoclopramide can be taken orally, it is often administered via injection. If nausea or vomiting is preventing patients from keeping medication in their system, for example, delivering Metoclopramide via injection ensures that the patient gets the benefit of the medication and that their symptoms are reduced.

Although nausea and vomiting can be caused by various factors, Metoclopramide can be effective in treating these symptoms, regardless of the cause. Whilst Metoclopramide can be used in isolation, it may also be used in conjunction with some other medications. If patients are given medication which is known to cause nausea or vomiting, for example, Metoclopramide may be given as a prophylactic to prevent these symptoms from occurring.

Conditions Treated

  • Nausea and vomiting
  • Gastroparesis

Type Of Medicine

  • Dopamine D2 antagonist

Side Effects

When Metoclopramide is used to treat patients, there are a number of side effects which can occur. In some instances, these side effects are most prominent when patients are first given Metoclopramide but tend to decrease over time.

For example, patients may experience the following when they are treated with Metoclopramide:

  • Irregular, missed or absent menstrual periods
  • Loss of vision
  • Cough
  • Decreased interest in sexual intercourse
  • Inability to have or keep an erection
  • Blurred vision
  • Diarrhea
  • Hives or welts
  • Disturbed color perception
  • Itching
  • Double vision
  • Muscle weakness or pain
  • Halos around lights
  • Loss of sexual performance, drive, desire or ability
  • Night blindness
  • Loss of energy or strength
  • Sleeplessness
  • Noisy breathing
  • Swelling of the breasts or unusual milk production
  • Overbright appearance of lights
  • Stopping of menstrual bleeding
  • Redness of the skin
  • Trouble sleeping
  • Swelling of the breasts or breast soreness in both male and females
  • Inability to sleep
  • Tunnel vision
  • Excessive or unexpected milk flow from the breasts
  • Unusual weak feeling

If the above side effects are relatively mild and short-lived, the patient may not require additional treatment. However, if the side effects are severe or do not reduce over time, patients should obtain medical advice.

In addition to this, patients should notify their doctor or nurse immediately if they experience any of the following symptoms after Metoclopramide has been administered:

  • Convulsions
  • Tiredness
  • Difficulty in breathing
  • Sticking out of the tongue
  • Fast heartbeat
  • Increased sweating
  • High fever
  • Loss of bladder control
  • Feeling, hearing or seeing things that are not there
  • Low or high blood pressure
  • Severe muscle stiffness
  • Inability to move the eyes
  • Trouble speaking, swallowing or breathing
  • Increased spasms or blinking of the eyelid
  • Uncontrolled twisting movements of the trunk, neck, legs or arms
  • Bluish-colored fingernails, palms or lips
  • Unusual facial expressions
  • Blurred vision
  • Unusually pale skin
  • Tarry, black stools
  • Chest discomfort or pain
  • Stomach or abdominal tenderness or pain
  • Chills
  • Inability to sit still
  • Clay-colored stools
  • Headache
  • Confusion
  • Hoarseness or cough
  • Dark urine
  • General feeling of weakness or tiredness
  • Decrease in the amount of urine
  • Fever, may be with or without chills
  • Decreased appetite
  • Fluid-filled skin blisters
  • Decreased urine output
  • Feeling of warmth
  • Difficulty in swallowing
  • Increased need to urinate
  • Dilated neck veins
  • Lightheadedness or dizziness
  • Itching of the skin
  • Fatigue
  • Lightheadedness, faintness or dizziness when getting up from a sitting or lying position suddenly
  • Slow, irregular, pounding or fast pulse or heartbeat
  • Extreme fatigue
  • Incremental or ratchet-like movement of the muscle
  • Fainting
  • Large, hive-like swelling on the lips, throat, tongue, face, eyelids, hands, feet, legs or sex organs
  • Palpitations
  • Light-colored stools
  • Pale skin
  • Loss of appetite
  • Difficulty or painful urination
  • Loss of balance control
  • Pain in lower back or side
  • Mask-like face
  • Rattling, noisy breathing
  • Mental depression
  • Slurred speech
  • Mood or mental changes
  • Urinating more often
  • Muscle discomfort
  • Slowed movements
  • Nausea and vomiting
  • Slow reflexes
  • Need to keep moving
  • Irregular or slow breathing
  • Nervousness
  • Swelling of the fingers, feet, lower legs or face
  • Slow movement
  • Pounding in the ears
  • Skin thinness
  • Fever and sore throat
  • Slow, pounding heartbeat
  • Rapid heart rate
  • Troubled breathing at rest
  • Redness of the arms, neck face and, sometimes, upper chest
  • Tightness in the chest
  • Shaking and trembling of the hands and fingers
  • Restlessness of the legs, feet, hands or arms
  • Weight gain
  • Stiff or rigid muscles
  • Yellowing of the skin or eyes
  • Sensitivity to the sun
  • Unusual weakness or tiredness
  • Tic-like (jerky) movements of the face, mouth, head and neck
  • Shakiness in the arms, legs, feet or hands
  • Changes in behavior
  • Thoughts of killing oneself
  • Sweating
  • Wheezing
  • Shortness of breath
  • Unusual bruising or bleeding
  • Shuffling walk
  • Rash on the skin
  • Ulcers, sores or white spots in the mouth or on the lips
  • Stiffness of the legs and arms

If patients experience any other side effects whilst they are being treated with Metoclopramide, they should report them to their medical team or obtain urgent help, if necessary. Patients should also be aware of the symptoms of a Metoclopramide overdose. If too much medication is administered or if Metoclopramide is administered too often, patients may experience the following symptoms:

  • Drowsiness
  • Confusion about place, time or identity

If patients exhibit these symptoms after being given Metoclopramide, emergency treatment may be required and the patient or their caregiver should notify a physician immediately.

Dosage

When patients are prescribed Metoclopramide, their exact dose will depend on their symptoms, the cause of their nausea and vomiting, their age, weight, medical history and the way in which Metoclopramide is to be administered.

If patients are given Metoclopramide via an intravenous injection for sickness caused by chemotherapy treatment, for example, they are usually given 2mg per kilogram of bodyweight. This should be infused over a fifteen-minute period and administered approximately thirty minutes before their chemotherapy treatment begins. If necessary, two further doses of Metoclopramide can be administered following the chemotherapy treatment, with at least two hours between doses. If the patient has ceased vomiting, their dose of Metoclopramide can be reduced to 1mg per kilogram of bodyweight for the following three doses, with at least three hours being left between doses. However, if the patient is still experiencing vomiting, their dose of Metoclopramide may be increased to 3mg per kilogram of bodyweight, administered every three hours for a further three doses.

Alternatively, patients may be given Metoclopramide if they are being treated for diabetic gastroparesis. If so, patients are usually given 10mg every six hours, with each dose being taken at least thirty minutes before meals and going to bed. When patients are being treated for diabetic gastroparesis, they are usually able to take Metoclopramide in oral form. However, if they are suffering from severe symptoms, Metoclopramide may be administered via intramuscular or intravenous injection.

If patients are given Metoclopramide prior to a radiological exam of the upper gastrointestinal tract, they are typically given 10mg via intravenous injection, over a period of one or two minutes.

When Metoclopramide is administered intravenously, an experienced healthcare practitioner will deliver the medication in a clinical setting, such as a treatment center or hospital. Whilst intra-muscular injections are often administered in the same way, patients may be given this form of injection in an external setting, if they are well enough to continue treatment at home. In most cases, a healthcare professional will administer the medication via injection and the patient will then be prescribed Metoclopramide in oral form.

Potential Drug Interactions:

As some drugs can interact with others, Metoclopramide should not be prescribed in conjunction with the following medicines:

  • Amitriptyline
  • Nefazodone
  • Amoxapine
  • Olanzapine
  • Aripiprazole
  • Mirtazapine
  • Asenapine
  • Nortriptyline
  • Bupropion
  • Paliperidone
  • Chlorpromazine
  • Perphenazine
  • Citalopram
  • Pimozide
  • Clomipramine
  • Paroxetine
  • Clozapine
  • Prochlorperazine
  • Desipramine
  • Quetiapine
  • Desvenlafaxine
  • Maprotiline
  • Doxepin
  • Rivastigmine
  • Duloxetine
  • Molindone
  • Escitalopram
  • Promethazine
  • Fluoxetine
  • Protriptyline
  • Fluphenazine
  • Thiothixene
  • Fluvoxamine
  • Haloperidol
  • Promazine
  • Iloperidone
  • Trazodone
  • Imipramine
  • Trifluoperazine
  • Loxapine
  • Venlafaxine
  • Lurasidone
  • Thioridazine
  • Mesoridazine
  • Trimethobenzamide
  • Risperidone
  • Ziprasidone

In addition to this, the use of Metoclopramide alongside the following medications is not usually advised:

  • Bromocriptine
  • Phenelzine
  • Digoxin
  • Rasagiline
  • Isocarboxazid
  • Selegiline
  • Linezolid
  • Tramadol
  • Milnacipran
  • Tranylcypromine

If patients are prescribed Metoclopramide alongside one of the medicines listed above, their dose may be modified or they may be given the medications at different times in order to try and prevent an interaction occurring.

Patients should also be aware that they could suffer from increased side effects if Metoclopramide is used at the same time as any of the following:

  • Cyclosporine
  • Sertraline
  • Didanosine
  • Tacrolimus
  • Levodopa
  • Succinylcholine
  • Mivacurium
  • Thiopental

In some cases, additional medication can be given to relieve the side effects caused by Metoclopramide, particularly if it is used in conjunction with chemotherapy medicines.

Before patients are treated with Metoclopramide, they should tell their physician if they are using any other medicines, vitamins or supplements and patients should obtain medical advice before using these substances once they have been treated with Metoclopramide.

Warnings

Before being given Metoclopramide, patients should tell their doctor if they have any other health problems. There are some conditions which may affect the use of Metoclopramide and these can include:

  • Stomach or abdominal bleeding
  • Intestinal blockage
  • Epilepsy or seizures
  • Pheochromocytoma
  • Cirrhosis
  • Asthma
  • Diabetes
  • Congestive heart failure
  • High blood pressure (Hypertension)
  • Neuroleptic malignant syndrome
  • Mental depression
  • Parkinson's disease
  • Kidney disease
  • Nicotinamide adenine dinucleotide (NADH) cytochrome reductase deficiency
  • Glucose-6-phosphate dehydrogenase (GSPD) deficiency

Specific studies into the effects of Metoclopramide on pediatric patients have not been performed. Children and infants may not, therefore, always be treated with Metoclopramide.

Although Metoclopramide can be used to treat geriatric patients, caution must be shown. Older patients are more likely to have age-related health problems which could require a modified dose of Metoclopramide to be administered. In addition to this, geriatric patients are more likely to experience side effects following treatment with Metoclopramide.

If patients experience any of the following symptoms whilst being treated with Metoclopramide, it may indicate that they have developed neuroleptic malignant syndrome (NMS) and urgent medical treatment will be required:

  • Unusually pale skin
  • Loss of bladder control
  • Seizures or convulsions
  • Difficulty breathing
  • High fever
  • Fast heartbeat
  • High or low blood pressure
  • Severe muscle stiffness
  • Increased sweating
  • Tiredness

Patients should notify a healthcare practitioner immediately if they experience any of the following symptoms during or following treatment with Metoclopramide:

  • Drooling
  • Difficulty speaking
  • Loss of balance control
  • Muscle stiffness, jerking or trembling
  • Shuffling walk
  • Restlessness
  • Uncontrolled movements of the back, neck or face
  • Twisting movements of the body
  • Stiffness of the lips

Metoclopramide can cause a movement disorder, known as tardive dyskinesia, and patients should obtain immediate medical help if they exhibit the following symptoms:

  • Lip puckering or smacking
  • Rapid or worm-like movements of the tongue
  • Uncontrolled chewing movements
  • Puffing of the cheeks
  • Uncontrolled movements of the legs or arms

Metoclopramide can make some patients feel drowsy, dizzy or less alert than usual. If affected in this way, patients should not operate machinery, drive or perform potentially dangerous tasks until these side effects have passed.

Metoclopramide can add to the effects of other central nervous system depressants and should not be in conjunction with them. These can include:

  • Alcohol
  • Seizure mediation
  • Allergy medicines
  • Cough, cold and flu medication
  • Barbiturates
  • Muscle relaxants
  • Sleeping medicines
  • Tranquilizers
  • Antihistamines
  • Prescription pain medication
  • Anesthetics, including dental anesthetics

Patients should tell any healthcare practitioner they consult that they have been treated with Metoclopramide, including their dentist.

To date, studies have not suggested that Metoclopramide poses a significant risk to pregnant patients. However, potential harm to the unborn fetus cannot be ruled out. Although Metoclopramide may be prescribed during pregnancy, it should not be used during labor or delivery.

If patients become pregnant following treatment with Metoclopramide, they should inform their physician immediately.

Although studies have been limited, data suggests that Metoclopramide can be excreted in breast milk and that it could cause harm to infants if transferred in this way. Patients may be advised not to breastfeed during and following treatment with Metoclopramide and should obtain medical advice before doing so.

In rare cases, patients may exhibit an allergic reaction whilst being treated with Metoclopramide and, if so, will require emergency medical treatment. The symptoms of an allergic reaction may include:

  • Difficulty breathing
  • Shortness of breath
  • Hives
  • Difficulty swallowing
  • Rash on the skin
  • Itching
  • Hoarseness
  • Swelling of the face, lips, tongue, mouth, throat or hands

Storage

Typically, Metoclopramide ampoules should be stored at a temperature below 25?C (77?F) and should be protected from light. However, Metoclopramide is administered by a healthcare professional so patients will not be required to store the medication at home.

Summary

When patients are experiencing severe or ongoing nausea and vomiting, it can be extremely debilitating and may cause serious health complications. By injecting patients with Metoclopramide, physicians can ensure that their nausea and vomiting is reduced, without the need for patients to try and take the medication orally.