Metoclopramide nasal spray: This is a dopamine-2 (D2) antagonist indicated for the relief of symptoms in adults with acute and recurrent diabetic gastroparesis.

Metoclopramide tablet:

• This is indicated in the treatment for 4 to 12 weeks of symptomatic, documented gastroesophageal reflux in adults who fail to respond to conventional therapy.
• It is also indicated for relief of symptoms in adults with acute and recurrent diabetic gastroparesis.

Metoclopramide Injection:

• Diabetic Gastroparesis (Diabetic Gastric Stasis): Metoclopramide Injection is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis.
• The Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy: Metoclopramide Injection is indicated for the prophylaxis of vomiting associated with emetogenic cancer chemotherapy.
• The Prevention of Postoperative Nausea and Vomiting: Metoclopramide Injection is indicated for the prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable.
• Small Bowel Intubation: Metoclopramide Injection may be used to facilitate small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers.
• Radiological Examination: Metoclopramide Injection may be used to stimulate gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and/or small intestine.

Metoclopramide blocks dopamine receptors and in higher doses, it also blocks serotonin receptors in the chemoreceptor trigger zone of the CNS. It enhances the response to acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions. It also increases lower esophageal sphincter tone.

Metoclopramide Spray:

 Adults less than 65 years of age: The recommended dosage is 1 spray (15 mg) in one nostril, 30 minutes before each meal and at bedtime (maximum of 4 sprays daily) for 2 to 8 weeks, depending on symptomatic response.

Adults 65 years of age and older: Metoclopramide is not recommended in geriatric patients as initial therapy. Geriatric patients receiving an alternative metoclopramide product at a stable dosage of 10 mg four times daily can be switched to Metoclopramide 1 spray (15 mg) in one nostril, 30 minutes before each meal and at bedtime (maximum four times daily) for 2 to 8 weeks, depending on symptomatic response.

Metoclopramide tablet:

 Gastroesophageal Reflux: Administer Metoclopramide continuously or intermittently.

• Continuous: 10 to 15 mg, 30 minutes before each meal and at bedtime (maximum 60 mg/day) for 4 to 12 weeks.
• Intermittent: Single doses up to 20 mg prior to provoking situation.

Acute and Recurrent Diabetic Gastroparesis: 10 mg, 30 minutes before each meal and at bedtime (maximum 40 mg/day) for 2 to 8 weeks.

Metoclopramide injection: 

For Diabetic Gastroparesis: Oral therapy may be started in mild cases. In severe cases, start with IM or IV injection. 10 mg may be given slowly IV over 1–2 minutes. Treatment may continue up to 10 days before switching to oral therapy.

For Chemotherapy-induced nausea and vomiting: IV infusion over at least 15 minutes, 30 minutes before chemotherapy. Repeat every 2 hours for 2 doses, then every 3 hours for 3 doses. Initial dose: 2 mg/kg for highly emetogenic drugs; 1 mg/kg for less emetogenic regimens.

For Postoperative nausea and vomiting: 10 mg IM near end of surgery; up to 20 mg may be used.

Metoclopramide is contraindicated:

• In patients with a history of tardive dyskinesia (TD) or dystonic reaction to metoclopramide.
• When stimulation of gastrointestinal motility may be dangerous (e.g., gastrointestinal hemorrhage, mechanical obstruction, or perforation).
• In patients with pheochromocytoma or catecholamine-releasing paragangliomas (may cause hypertensive crisis).
• In patients with epilepsy (may increase seizure frequency and severity).
• In patients with hypersensitivity to metoclopramide (may cause angioedema or bronchospasm).

Most common adverse reactions (≥5%) are dysgeusia, headache, and fatigue.

Pregnancy Category B. Animal studies (rats, mice, rabbits) at high doses showed no fetal harm or fertility impairment. However, adequate controlled studies in pregnant women are not available. Use only if clearly needed.

Nursing Mothers: Metoclopramide is excreted in human milk. Caution should be taken when used during breastfeeding.

Tardive Dyskinesia (TD), other extrapyramidal symptoms (EPS), and neuroleptic malignant syndrome (NMS) may occur. Avoid use with other drugs causing these conditions and avoid use in Parkinson’s disease. Discontinue if symptoms develop.

Depression and suicidal ideation/suicide risk: Avoid use.

Anti-emetic drugs, Prokinetic drugs

Store between 20–25°C. Protect from light.