Metoclopramide (Oral)

Patients who have the disease diabetes may also suffer from a stomach condition known as gastroparesis; Metoclopramide is a drug that treats the symptoms of this condition.

Overview

Metoclopramide is a medication that is used for treating symptoms which stem from a type of stomach condition known as gastroparesis, occurring in some patients who are diagnosed with diabetes. Metoclopramide works by enhancing or increasing contractions and muscle movements in the stomach and also in the intestines. By increasing this type of action, the drug helps provide relief from symptoms of diabetes including feeling nauseous, vomiting, experiencing heartburn, having a bloated tummy or full feeling after eating, or losing one's appetite. Metoclopramide may also be prescribed for patients who suffer heartburn due to gastroesophageal reflux disease, or GERD. GERD, an irritation of the throat and esophagus, is the result of gastric acid which slashes or flows backwards from the stomach upward into the esophagus.

Metoclopramide is available in multiple forms, including tablets or dissolving tablet, in a syrup form, as well as a liquid. This discussion involves the tablet, or oral, form of the medication. Metoclopramide is only available by prescription from a physician. The general dose for adults is one 10 milligram (mg) tablet taken up to four times per day, either before symptoms occur, or before meals and at bedtime.

Patients using Metoclopramide should take the medication as directed, and should not take more or less than is prescribed. Patients should also refrain from taking the medication more or less frequently than prescribed, at the risk of experiencing unwanted side effects. The package for this drug will include a guide explaining dosage and warnings. Patients should be sure to read the entire guide and contact their doctor if they do not understand any of the information.

Patients may experience certain side effects, such as a feeling of sleepiness or drowsiness, feeling restless, or having diarrhea. There are certain other rarer side effects which patients should report to their physician, such as headaches, increases in blood pressure, nausea and vomiting, or muscle spasms, uncontrolled muscle movements or difficulty moving. Taking Metoclopramide can also result in a patient getting a condition known as tardive dyskinesia, in which the patient experiences inability to control muscle movements.

Conditions Treated

  • Gastroesophageal reflux disease (GERD) resulting from diabetes

Type Of Medicine

  • Prokinetic

Side Effects

All medications have the potential to cause side effects, along with the intended effects for which the medication is prescribed. The list of side effects here is not complete but gives an idea of the range of reported side effects. While many people taking Metoclopramide may experience no side effects at all, patients who do experience any of these side effects should contact their doctor and seek further medical attention, as they may indicate a potentially severe reaction to the drug.

Some of the more common side effects patients have reported include feelings of being dizzy, feeling tired or sleepy, being agitated or irritable, experiencing abnormal headaches, and diarrhea. If these side effects do not subside or if they become worse, patients should contact their doctor as soon as possible.

Some patients may experience rarer, but more concerning side effects, such as changes in mood (unusual anxiety, depression, confusion or suicidal thoughts); lowered sexual interest; uncontrollable muscle movements or spasms (which may include arching the back or twisting the neck); being unable to stay still or the need to keep moving or pacing; symptoms that mirror Parkinson's disease (such as flat facial expression, difficulty moving, or shivering/shaking); noticeable tenderness or enlargement of the breasts; or, in women, any change to normal menstruation. Patients having these symptoms should contact their doctor right away.

Metoclopramide has been reported to also, in rare cases, cause an extremely serious condition called neuroleptic malignant syndrome, or NMS. This condition results in symptoms such as being severely confused, having a fever, sweating, stiffness in the muscles, and an irregular or fast heartbeat. Patients experiencing these symptoms should contact their doctor immediately.

There are also some rare side effects, which, if the patient experiences any of these, he or she should contact their doctor immediately. These include:

  • Pain/tenderness in the stomach or abdomen
  • Fever and chills
  • Stools having a clay color
  • Seizures or convulsions
  • Dark
  • Having trouble breathing, speaking or swallowing
  • Feeling dizzy or fainting
  • Irregular or fast heartbeat
  • Feeling tired, weak, run down
  • An unusually severe headache
  • Eyes are unable to move
  • Higher than usual blood pressure
  • Unusual sweating
  • Itching
  • Uncontrollable lip movements such as puckering
  • Lessened appetite
  • Lack of balance
  • Unable to control bladder
  • Muscle spasms in the back, neck or face
  • Vomiting or nausea
  • Rapid tongue movements
  • Slow walk or shuffle
  • Rashes on the skin
  • Stiff legs or arms
  • Swollen feet or legs
  • Twitching
  • Shaking or shivering fingers or hands
  • Twisting the body
  • Uncontrolled movements of legs, arms, tongue, mouth
  • Yellow skin or eyes

Patients who take excessive amounts of Metoclopramide may overdose and should seek emergency medical care if they experience severe drowsiness or extreme confusion.

While some side effects may not require medical attention and may disappear as the medication has its desired effect, patients should seek medical help if they have any concerns. A doctor may provide additional treatment to reduce unwanted side effects. Patients should contact their doctor with any concerns or questions.

The list above is not intended to describe all possible side effects. Patients who experience any discomfort or unusual side effects while taking Metoclopramide should contact their doctor. Patients can also report their side effects to the FDA, by calling 1-800-FDA-1088.

Dosage

A doctor will prescribe a dose of this medication based on each individual patient's medical history and the severity of the form of GERD being treated. Patients should always follow the physician's instructions in order to avoid side effects or possible overdose.

Below is the average dosage information, which will vary from patient to patient. Patients should not change their dosage without their doctor's instructions. Metoclopramide will be prescribed based on the drug's strength, number of times the patient should take it each day, and for how long the patient should continue taking the drug.

For the average adult patient, taking Metoclopramide in tablet form, the dose will depend on the condition being treated. For adult or teen patients with gastroparesis resulting from diabetes, a doctor may prescribe 10 mg, to be taken at least 30 minutes before they might likely experience symptoms, on an empty stomach, or to be taken just before eating a meal, and again just before bed. This dose may be prescribed to be taken as much as four (4) times per day.

For the average adult or teen patients with GERD (gastroesophageal reflux disease), a doctor may prescribe 10 to 15 mg, which should also be taken at least 30 minutes before the patient may experience symptoms, or taken just before a meal or before going to bed. This dosage amount may be prescribed to be taken up to 4 times per day.

This medication is not recommended to be prescribed for children, without the direction of a doctor.

Some patients may be prescribed the dissolving form of Metoclopramide tablet. For patients taking this type of tablet, they should take care to handle the medication with dry hands and to leave the tablet in the packaging until just before use. The tablet is then placed on the tongue until it melts.

Patients who miss a regular dose should take the missed dose as soon as they can. The dose should be skipped if it is close to the time for the next dose, and the patient should just take the next regular dose. It is important not to take double doses of this medication, to avoid unwanted side effects.

Major Drug Interactions

It is possible that some medications the patient is taking may interact with Metoclopramide, causing unwanted or dangerous side effects. A doctor may determine that the patient should continue both medications, or may alter one or both prescriptions. As a result, it's important that the patient provide the doctor with a complete list of all other medications the patient may be taking, before they begin taking Metoclopramide.

Some medications that have possible interactions with Metoclopramide are: atovaquone, antipsychotic medications including haloperidol and aripiprazole, dopamine agonists (for example pergolide, cabergoline, or ropinirole), pramlintide, fosfomycin, rivastigmine, and phenothiazines including prochlorperazine or promethazine.

Metoclopramide may also have an effect on how patients absorb other medications, as the drug speeds the movement of food or medicine through the stomach. A doctor or pharmacist can provide more information.

The patient should inform their doctor if they take other drugs that produce tiredness or drowsiness, such as alcohol, antihistamines, marijuana, or other medications prescribed for anxiety or sleep disorders, including diazepam, alprazolam, or zolpidem, as well as muscle relaxers or narcotics such as codeine.

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Below are additional generic medications that may interact with Metoclopramide. Patients should inform their doctor if they are taking any of the following medications:

  • Acetaminophen / tramadol
  • Acetaminophen / propoxyphene
  • Amyl nitrite / sodium nitrite / sodium thiosulfate
  • Amitriptyline / perphenazine
  • Amoxapine
  • Aripiprazole
  • Bupropion / naltrexone
  • Cariprazine
  • Clozapine
  • Codeine / phenylephrine / promethazine
  • Dextromethorphan / promethazine
  • Deutetrabenazine
  • Droperidol / fentanyl
  • Epinephrine / prilocaine
  • Fluphenazine
  • Fluoxetine / olanzapine
  • Haloperidol
  • Loxapine
  • Lidocaine / prilocaine topical
  • Mesoridazine
  • Methotrimeprazine
  • Molindone
  • Olanzapine
  • Paliperidone
  • Phenylephrine / promethazine
  • Prilocaine
  • Promazine
  • Propiomazine
  • Sodium nitrite
  • Triflupromazine
  • Trimeprazin
  • Tetrabenazine
  • Thiothixene
  • Tramadol
  • Thiethylperazine
  • Thioridazine
  • Trifluoperazine

Doctors may recommend certain food restrictions while taking Metoclopramide, as well as whether alcohol or tobacco products may interact with this medication. Patients who use these products should consult their doctor.

Warnings

There are certain precautions required for patients who are taking Metoclopramide. In some cases, the doctor may determine that the patient will benefit from taking Metoclopramide even where there may be some risks. The warnings listed here should be taken into consideration when deciding whether to use Metoclopramide.

Some patients may have an allergic reaction to taking Metoclopramide. Patients should inform their doctor if they have ever had such a reaction to Metoclopramide in the past, or any other medication, as well as any allergic reactions to food.

Patients may experience headaches, dizziness, or nervousness while taking Metoclopramide; however, these effects should lessen after taking Metoclopramide for a few days. Patients should contact their doctor if the effects continue, or if they have any questions.

There have been insufficient studies of the effects of Metoclopramide on children, and as a result, it is not recommended for use by children under the age of 18.

For older patients, the studies so far have not shown that there are specific age-related problems arising from the use of Metoclopramide. It is possible that senior patients may be more susceptible to getting such side effects as confusion, drowsiness, tardive dyskinesia, or kidney problems (for which the doctor may modify the dose of Metoclopramide).

In pregnant or breastfeeding women, studies have not shown a risk to a fetus from taking Metoclopramide. However, Metoclopramide may cause increased production of breast milk in lactating women. Patients should discuss potential side effects with their doctor.

Patients who are currently suffering from other medical conditions may be affected by taking Metoclopramide, and should discuss with their doctor if they have any of the following:

  • Stomach or abdominal
  • Any intestinal perforation or blockage
  • Tumor of the adrenal gland (pheochromocytoma)
  • Epilepsy or seizures these patients should not take Metoclopramide
  • Asthma
  • Liver disease (cirrhosis)
  • Diabetes or
  • Heart disease or congestive heart failure or
  • Heart arrhythmia (irregular heartbeat)
  • Changes in blood pressure
  • Depression, or a history of depression
  • Neuroleptic malignant syndrome or a history of NMS
  • Parkinson's disease Metoclopramide may worsen this condition
  • Enzyme deficiency, specifically Glucose-6-phosphate dehydrogenase (G6PD) or nicotinamide adenine dinucleotide cytochrome reductase deficiency (NADH) patients may be at increased risk of side effects
  • Kidney disease may be impacted by using Metoclopramide

Patients taking Metoclopramide should schedule regular doctor visits to review progress and to ensure the medication is providing the expected results.

Taking Metoclopramide with alcohol or other depressants (affecting alertness or causing drowsiness) can increase the effects. Patients should discuss with their doctor if they take products such as antihistamines, cold or cough medicine, sleeping aids, tranquilizers, seizure medication, muscle relaxers, or any kind of an anesthetic (including for dental procedures).

Patients taking Metoclopramide should use caution when driving or using machines due to potential drowsiness or dizziness.

Metoclopramide can cause the disorder known as tardive dyskinesia, which affects movement. Patients should immediately stop taking Metoclopramide and contact their doctor if they experience any of the following: uncontrollable lip puckering smacking, puffing out of cheeks, worm-like or rapid tongue movements, uncontrollable chewing, or any uncontrollable arm or leg movements. Patients are at greater risk of having tardive dyskinesia if they take Metoclopramide for more than 12 weeks. Patients should not take Metoclopramide for more than 12 weeks without the express instruction of their doctor.

Patients should contact their doctor immediately if they experience any of the following while taking Metoclopramide: unable to move his or her eyes; spasms or blinking the eyelids; difficulty breathing, swallowing or speaking; uncontrollable movements of the tongue; uncontrollable twisting of the torso, neck, legs or arms; abnormal facial movements or expressions; or weakness in the legs or arms.

Patients should stop taking Metoclopramide and immediately contact their doctor if they experience any of the following: seizures or convulsions; trouble breathing; a rapid heartbeat; spiking fever; change in blood pressure; unusual sweating; unable to control bladder; unusually stiff muscles; abnormally pale skin; or drowsiness. These symptoms may indicate a serious problem known as neuroleptic malignant syndrome (NMS).

While taking Metoclopramide, patients should not take any other medications, including non-prescription medications, supplements or vitamins, without first discussing with their doctor.

Storage

Metoclopramide should be kept tightly closed, and stored at room temperature. Keep away from moisture, heat and direct light. Do not freeze.

Patients should keep this and all medications in a location where it cannot be accessed accidentally by children. For medications that have expired or are no longer used, contact a healthcare professional or local law enforcement to find out where to safely dispose of unneeded drugs.

Summary

Metoclopramide is prescribed for diabetes patients who may suffer from a stomach condition known as gastroparesis. Metoclopramide affects the stomach muscles to provide relief from such symptoms as nausea, vomiting, heartburn and other related stomach problems. Metoclopramide is also prescribed for patients with gastroesophageal reflux disease or GERD.

The average dose for adults is one 10 milligram (mg) tablet which can be taken up to four times per day, before meals or before going to bed.

There are certain serious side effects and other conditions that can be caused by Metoclopramide. Patients should only take this medication as directed in order to reduce the possibility of side effects. Some of these may include feeling sleepy or drowsy, feeling restless, or having diarrhea. Other rarer side effects may include headaches, blood pressure changes, nausea and vomiting, or muscle spasms. Taking Metoclopramide can also result in patients getting a more severe condition known as tardive dyskinesia, which may result if patients take this medication for longer than 12 weeks.

Patients should have regular follow up visits to their doctor to determine their progress while taking Metoclopramide.