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metoclopramide

Drug Name


Generic Name : metoclopramide

Brand Name:  Apo-Metoclop (CAN), Nu-Metoclopramide (CAN), Octamide PFS, Reclomide, Reglan

Classification: GI stimulant, Antiemetic, Dopaminergic blocker

Pregnancy Category B

Dosage & Route



Available forms : Tablets—5, 10 mg; concentrated solution—10 mg/mL; injection—5 mg/mL

ADULTS
  • Relief of symptoms of gastroparesis: 10 mg PO 30 min before each meal and at bedtime for 2–8 wk. If symptoms are severe, initiate therapy with IM or IV administration for up to 10 days until symptoms subside.
  • Symptomatic gastroesophageal reflux: 10–15 mg PO up to four times/day 30 min before meals and at bedtime. If symptoms occur only at certain times or in relation to specific stimuli, single doses of 20 mg may be preferable; guide therapy by endoscopic results. Do not use longer than 12 wk.
  • Prevention of postoperative nausea and vomiting: 10–20 mg IM at the end of surgery.
  • Prevention of chemotherapy-induced emesis: Dilute and give by IV infusion over at least 15 min. Give first dose 30 min before chemotherapy; repeat q 2 hr for 2 doses, then q 3 hr for 3 doses. The initial two doses should be 2 mg/kg for highly emetogenic drugs (cisplatin, dacarbazine); 1 mg/kg may suffice for other chemotherapeutic drugs. If extrapyramidal symptoms occur, administer 50 mg of diphenhydramine IM.
  • Facilitation of small bowel intubation, gastric emptying: 10 mg (2 mL) by direct IV injection over 1–2 min.
PEDIATRIC PATIENTS
  • Facilitation of intubation, gastric emptying:
    • < 6 yr: 0.1 mg/kg by direct IV injection over 1–2 min.
    • 6–14 yr: 2.5–5 mg by direct IV injection over 1–2 min.

Therapeutic actions
  • Metoclopramide enhances the motility of the upper GI tract and increases gastric emptying without affecting gastric, biliary or pancreatic secretions. It increases duodenal peristalsis which decreases intestinal transit time, and increases lower oesophageal sphincter tone. It is also a potent central dopamine-receptor antagonist and may also have serotonin-receptor (5-HT3) antagonist properties.

Indications
  • Relief of symptoms of acute and recurrent diabetic gastroparesis
  • Short-term therapy (4–12 wk) for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy
  • Parenteral: Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy
  • Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable
  • Single-dose parenteral use: Facilitation of small-bowel intubation when tube does not pass the pylorus with conventional maneuvers
  • Single-dose parenteral use: Stimulation of gastric emptying and intestinal transit of barium when delayed emptying interferes with radiologic exam of the stomach or small intestine
  • Unlabeled uses: Improvement of lactation (doses of 30–45 mg/day); treatment of nausea and vomiting of a variety of etiologies: Emesis during pregnancy and labor, gastric ulcer, anorexia nervosa

Adverse effects
  • Extrapyramidal symptoms, restlessness, drowsiness, anxiety, diarrhoea, hypotension, hypertension, headache, depression, blood disorders (e.g. aganulocytosis, methaemoglobinaemia), hypersensitivity reactions (e.g. bronchospasm, rash), galactorrhoea or related disorders, transient increase in plasma aldosterone levels.
  • Potentially Fatal: Neuroleptic malignant syndrome; cardiac conduction disorders may occur with IV dosage form.

Contraindications
  • GI haemorrhage, mechanical obstruction and perforation; phaeochromocytoma; history of seizures.

Nursing considerations

Assessment
  • History: Allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, pheochromocytoma, epilepsy, lactation, previously detected breast cancer
  • Physical: Orientation, reflexes, affect; P, BP; bowel sounds, normal output; EEG
Interventions
  • Monitor BP carefully during IV administration.
  • Monitor for extrapyramidal reactions, and consult physician if they occur.
  • Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption.
  • WARNING: Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM).
  • WARNING: Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma).
Teaching points
  • Take this drug exactly as prescribed.
  • Do not use alcohol, sleep remedies, sedatives; serious sedation could occur.
  • You may experience these side effects: Drowsiness, dizziness (do not drive or perform other tasks that require alertness); restlessness, anxiety, depression, headache, insomnia (reversible); nausea, diarrhea.
  • Report involuntary movement of the face, eyes, or limbs, severe depression, severe diarrhea.




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