Metoclopramide

Brand names

• Apo-Metoclop
• Clopra
• Emex
• Gastrobid
• Maxeran
• Maxolon
• Nu-Metoclopramide
• Octamide
• PMS-Metoclopramide
• Reclomide
• Reglan

Usage

To prevent nausea and vomiting caused by anticancer medicines or to treat impaired emptying of food from the stomach (gastroparesis) as a complication of diabetes. Also used as a short-term treatment for heartburn (gastroesophageal reflux, a backflow of stomach acid into the esophagus).

How it works

Metoclopramide increases the contractions or movements of the stomach and small intestine. It decreases nausea by blocking the effect of the chemical dopamine in the vomiting center of the brain.

Side effects

Serious

Muscle spasms, aching or crawling sensation in lower legs, stiffness or uncontrolled movements of arms or legs, panicky feeling, unusual nervousness, restlessness, irritability, difficulty speaking or swallowing, dizziness or fainting, fast or irregular heartbeat, general fatigue, shaking of hands and fingers, uncontrolled chewing movements, lip smacking or puckering, loss of balance, severe headache, unusual tongue movements, difficulty walking or shuffling walk.

Common

Diarrhea, restlessness, drowsiness.

Less common

Breast tenderness and swelling, increased flow of breast milk, menstrual changes, depression, constipation, nausea, skin rash, insomnia, dryness of mouth.

Possible interactions

Other medicaments:

Metoclopramide may decrease the effects of:

• cimetidine (Tagamet).
• digoxin (slow-dissolving dose forms) and reduce its effectiveness.

Metoclopramide taken concurrently with:

• acetaminophen may increase the absorption of this medicament; decreased doses are prudent if chronic acetaminophen use will continue with metoclopramide therapy.
• major antipsychotic medicaments (phenothiazines, thiothixenes, haloperidol, etc.) may increase the risk of developing Parkinson-like reactions.
• cyclosporine (Sandimmune) may result in increased cyclosporine levels and toxicity.
• morphine (slow release) may result in faster onset and increased sedation.
• penicillin may result in decreased therapeutic benefits of the antibiotic; increased doses may be needed.
• quinidine (Quinaglute, others) may result in decreased therapeutic benefits from quinidine; increased blood level testing and adjustment of dosing to levels is indicated.
• serolimus (Rapamune) or tacrolimus (Prograf) may result in toxicity.
• sertraline (Zoloft) may increase risk of movement disorders.
• zalcitabine (Hivid) may blunt zalcitabine levels and benefits.

The following medicaments may decrease the effects of metoclopramide:

• atropinelike medicaments.
• opioid analgesics.
• ritonavir (Norvir).

Herbal medicines or minerals:

Valerian and kava kava may intensify drowsiness. Aloe, cascara and senna may increase possibility of diarrhea. Using chromium may change the way your body is able to use sugar. Some health food stores advocate vanadium as mimicking the actions of insulin, but possible toxicity and need for rigorous studies presently preclude recommending it. DHEA may change sensitivity to insulin or insulin resistance. Hawthorn, ginger, garlic, ginseng and licorice, nettle and yohimbe may change blood sugar. Since this may require adjustment of hypoglycemic medicine dosing, talk to your doctor before combining any of these herbal medicines with metoclopramide. Echinacea pupurea (injectable) and blonde psyllium seed or husk should not be taken by people living with diabetes.

Alcohol:

Combined effects can result in excessive sedation and marked intoxication. Alcohol is best avoided.

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