Metoclopramide

Drug Data Generic Name Metoclopramide Trade Name Reglan, Maxolon Dosages 10-15 mg PO up to 4 times/day 30 minutes before each meal and at bedtime for 2-8 weeks

Classification Pharmacologic Class Dopaminergic blocker Therapeutic Class Antiemetic GI stimulant Pregnancy Risk Factor B

Contents Metoclopramide

Mechanism of Action Stimulates motility of upper GI tract without stimulating gastric, billiary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin. Pharmacokinetics D: Crosses placenta; enters breast milk M: Hepatic E: Urine

Availability and color Tablets: 5, 10 mg Oral solution: 1 mg/mL Injection: 5 mg/mL

Drug Half Life 5-6 hours

Routes of administration Oral Intramuscular Intravenous

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 783784

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 783

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 783-784

Indication - Relief of symptoms of acute and reccurent diabetic gastroparesis - Short-term therapy for adults with symptomatic GERD who fail to respond to conventional therapy - Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy - Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable - Facilitation of smallbowel intubation when tube does not pass the pylorus with conventional maneuvers - Stimulation of gastric emptying and intestinal transit of barium when delayed emptying interferes with radiologic examination of the stomach or small intestine - Unlabeled uses: Improvement of lactation; treatment of nausea and vomiting of a variety of etiologies: hyperemesis gravidarum, gastric ulcer, anorexia nervosa

Contraindications Concentrations - Allergy to metoclopramide - GI hemorrhage - Mechanical obstruction or perforation - Pheochromocytoma - Epilepsy

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 783

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 783-784

Precaution - Previously detected breast cancer - Lactation - Pregnancy - Fluid overload - Renal impairment

Adverse Reaction CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal reactions, parinsonismlike reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: Transient hypertension GI: Nausea, diarrhea

Drug interaction Drug to drug - Decreased absorption of digoxin from the stomach - Increased toxic and immunosuppressive effects of cyclosporine - Increased neuromuscular blocking effect of succinylcholine

Nursing Responsibilities Before - Observe 15 rights in drug administration. - Assess for allergy to metoclopramide. - Assess for other contraindications. - Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). - Have phentolamine readily available in case of hypertensive crisis. During - Monitor BP carefully dring IV administration. - Monitor for extrapyramidal reactions, and consult physician if they occur. - Monitor diabetic patients. - Give direct IV doses slowly over 1-2 minutes. - For IV infusion, give over at least 15 minutes. After - Dispose of used materials properly. - Educate patient about side effects. - Instruct to report involuntary movement of the face, eyes, or limbs, severe depression, severe diarrhea. - Instruct patient to take drug exactly as prescribed. - Instruct not to use alcohol, sleep remedies or sedatives; serious sedation could occur. - Do proper documentation.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 784

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 784-785