Alternate Name(s):
MAXERAN®, REGLAN®, METONIA®
Classification:
Gastrointestinal Agent, Prokinetic.
Original Date:
March 2023
Indications:
- Management of delayed gastric emptying, if oral therapy not feasible.
- It is recommended to try domperidone as a motility agent first if possible, due to the adverse effect profile and pediatric warnings associated with metoclopramide. Any intestinal mechanical obstruction (e.g., stenosis, stricture, adhesive band), perforation, or hemorrhage must be ruled out before starting this medication
Administration:
- IV direct: no
- IV intermittent infusion: over 15-30 minutes
- Infusion rate: do not exceed 5 mg/minute
Dosage:
- Initial dose IV : 0.1 mg/kg/day, divided q8h.
- Maximum dose IV: 0.5 mg/kg/day.
Side Effects:
- Lethargy, irritability, hypertension, QTc prolongation, extrapyramidal reactions and potential for permanent tardive dyskinesia.
- Many adverse effects are dose and/or age-related.
Parameters to Monitor:
- HR, BP
- Monitor for abnormal movements of the facial muscles, mouth, tongue, limbs, or pelvis
- Renal and hepatic function (dose reduction may be required)
Reconstitution and Stability:
CHEO:
Metoclopramide HCL 5 mg/mL vial (for doses < 0.5 mg)
- Take 0.4 mL (2 mg) and dilute with 19.6 mL of D5W or 0.9% NaCl
- Final concentration: 0.1 mg/mL
Metoclopramide HCL 5 mg/mL vial (for doses > 0.5 mg)
- Take 1 mL (5 mg) and dilute with 9 mL of D5W or 0.9% NaCl
- Final concentration: 0.5 mg/mL
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl, D5W/0.45%NaCl, ringer's solution, ringer's lactate
- Y-site Compatible: acetaminophen, atropine, azithromycin, caffeine, cefazolin, cefotaxime, clindamycin, cloxacillin, dexmedetomidine, dexamethasone, dobutamine, dopamine, epinephrine, famotidine, fluconazole, furosemide (< 5 mg/mL) gentamicin, hydrocortisone sodium succinate, hydormorphone, heparin, ketamine, lidocaine HCL, lorazepam, meropenum, midazolam, morphine, octreotide, penicillin G sodium, potassium chloride, tobramycin, TPN (amino acids/dextrose), vancomycin
- Incompatible: ampicillin, pantoprazole
Notes:
- Metoclopramide is not recommended for the management of gastroesophageal reflux in pediatric patients due to increased risk of adverse events and lack of data showing efficacy
- Risk of methemoglobinemia in neonates (neonates may have decreased levels of NADH-cytochrome b5 reductase, which increases the risk of methemoglobinemia).
- Intestinal obstruction (e.g., stenosis, stricture, adhesive band), perforation, or hemorrhage must be ruled out before starting this medication
- Metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. There is no known treatment for tardive dyskinesia. The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose. Discontinue metoclopramide in patients who develop signs or symptoms of tardive dyskinesia.
References:
- The Hospital for Sick Children 2020 Drug Handbook and Formulary.
- Amin SC, Pappas C, Iyengar H, Maheshwari A. Short bowel syndrome in the NICU. Clin Perinatol. 2013;40(1):53-68.
- Tillman EM, Smetana KS, Bantu L, Buckley MG. Pharmacologic Treatment for Pediatric Gastroparesis: A Review of the Literature. J Pediatr Pharmacol Ther. 2016;21(2):120-132.
- Lexi-Comp Database, accessed April 2022
- Mussavi M, Asadollahi K, Abangah G. Effects of Metoclopramide on Feeding Intolerance among Preterm Neonates; A Randomized Controlled Trial. Iran J Pediatr. 2014;24(5):630-636.