Drug Analysis- Metoclopramide

GENERIC NAME: Metoclopramide BRAND NAME: Reglan DRUG CLASS: Metoclopramide is a "prokinetic" agent that increases muscle tone of the lower esophagus sphincter. The lower esophagus sphincter, located between the esophagus and stomach, normally prevents reflux of acid and other stomach contents into the esophagus. Metoclopramide decreases stomach acid reflux by strengthening the lower esophagus sphincter. metoclopramide also hastens the stomach emptying of solid and liquid meals into the intestines. Rapid emptying of meals also helps decrease the reflux of stomach acid and other contents into the esophagus. Metoclopramide interferes with dopamine receptors in the brain. Since dopamine causes nausea. Metoclopramide can be an effective anti-nausea medication. PRESCRIPTION: no PREPARATIONS: tablets: 5 mg and 10mg. Syrup: 5 mg/5 ml PRESCRIBED FOR: Metoclopramide is used on a short term basis (4 to 12 weeks) for patients with heartburn and esophagitis due to gastroesophageal reflux. Stomach nerve damage due to diabetes (diabetic gastric stasis) can cause delayed stomach emptying, resulting in nausea, vomiting, fullness, and heartburn. Metoclopramide can be effective in relieving nausea and other symptoms related to diabetic gastric stasis. Metoclopramide is also used in the treatment of nausea related to postoperative state and cancer chemotherapy. DOSING:  To increase movements or contractions of the stomach and intestine: o Adults and teenagers—10 mg injected into a vein.  To prevent vomiting after surgery: o Adults and teenagers—10 to 20 mg injected into a muscle near the end of surgery. DRUG INTERACTIONS: Metoclopramide can have nervous system side effects, such as depression, anxiety, sedation, restlessness, and insomnia. Parkinson patients can experience worsening of symptoms with metoclopramide. Metoclopramide may impair the mental and/or physical abilities to drive or operate machinery. Rarely, metoclopramide can cause involuntary muscle movements, facial grimacing, and dystonic reactions resembling tetanus. Since metoclopramide accelerates stomach emptying, it can increase absorption and effects of other medications. For example, the effects of sedatives such as alcohol and diazepam (Valium) can be accelerated when used together with metoclopramide. Safety in pregnancy, nursing mothers, and children has not been established. SIDE EFFECTS: Metoclopramide is generally well tolerated when used in low doses for brief periods. The nervous system side effects increase with higher doses and longer periods of treatment. The common side effects are mentioned above under Drug Interaction

•

More common o Diarrhea—with high doses; drowsiness ; restlessness

•

Less common or rare o Breast tenderness and swelling; changes in menstruation; constipation; decreased interest in sexual intercourse; inability to have or keep an erection; increased flow of breast milk; increased need to urinate; loss in sexual ability, desire, drive, or performance; mental depression; nausea; passing urine more often; skin rash; trouble in sleeping; unusual dryness of mouth; unusual irritability

CONTRAINDICATIONS:  Do not take metoclopramide if you have: o bleeding, an injury, or an obstruction in your stomach; o pheochromocytoma; o epilepsy or another seizure disorder  Before taking this medication, tell your doctor if you have o Abdominal or stomach bleeding or o Asthma or o Cirrhosis (liver disease) or o Congestive heart failure or o High blood pressure or o Intestinal blockage or o Mental depression or o Parkinson's disease or o Pheochromocytoma (catecholamine-producing tumor)—Metoclopramide may make these conditions worse o Epilepsy—Metoclopramide may increase the risk of having a seizure o Kidney disease (severe)—Higher blood levels of metoclopramide may result, possibly increasing the chance of side effects o Nicotinamide adenine dinucleotide (NADH) methemoglobin reductase deficiency—Metoclopramide may increase your  Metoclopramide passes into breast milk. o Do not take metoclopramide without first talking to your doctor if you are breast-feeding a baby. o NURSING RESPONSIBILITIES:  The nurse should assess the patient for N/V, abdominal distention, bowel sounds before and after, extrapyramidal side effects, tardive dyskinesia, and for signs of depression.  Give metoclopramide exactly as directed by your doctor  Give the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.  Observe the client for severe side effects  the nurse should know that this drug could alter hepatic function test results