Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Metoclopramide

USE IF: Short-term nausea/vomiting; migraine-associated nausea (adjunct); selected gastroparesis / gastric emptying facilitation when obstruction excluded and benefit clear.

AVOID IF: Mechanical GI obstruction, perforation, or GI bleeding where prokinetics are unsafe; pheochromocytoma; prolonged casual PRN without neurologic risk review; significant EPS vulnerability without neurology input.

Metoclopramide

Dopamine antagonist / prokinetic (antiemetic)

AdultAntiemeticGIMigraineERWardClinicNeurology

Indication

Short-term antiemetic • Migraine nausea adjunct • Selected gastroparesis (time-limited)

At a glance

INDICATIONS (CORE USE)

- Nausea / vomiting - Migraine-associated nausea (adjunct) - Gastroparesis (selected, time-limited) - Facilitation of gastric emptying in selected contexts

ADULT DOSE (STANDARD)

Common antiemetic: 10 mg PO / IV / IM Repeat / schedule per indication and protocol Adjust in renal impairment

MAX DOSE

No single universal ceiling — keep clinically safe; emphasize renal adjustment, lowest effective dose, and strict duration limits (tardive dyskinesia risk)

Route

PO / IV / IM

PEDIATRIC DOSE

Specialist / weight-based / protocol-driven only

Do not miss

Must-not-miss safety points

Major warning

- Extrapyramidal symptoms (dystonia, akathisia) can occur early - Tardive dyskinesia risk increases with prolonged use → avoid chronic casual prescribing - Sedation / CNS effects - Dose-reduce in renal impairment - Do not use when prokinetic effect is dangerous (e.g., mechanical obstruction)

Indications

Primary

  • Nausea / vomiting
  • Migraine-associated nausea (adjunct)
  • Gastroparesis (selected use, time-limited)
  • Facilitation of gastric emptying in selected contexts

Secondary

  • Reflux / dysmotility (selected specialist use)

Dosing

STANDARD (ADULT PO)

Adult common antiemetic: 10 mg PO / IV / IM — repeat / schedule per indication and protocol

ADULT DOSE

STANDARD (ADULT): - Common antiemetic dosing: 10 mg PO / IV / IM - Repeat / schedule per indication and protocol - Adjust in renal impairment

PEDIATRIC DOSE

Specialist / weight-based / protocol-driven only

MAX DOSE

Keep clinically safe; avoid oversimplified absolute claims — emphasize renal adjustment and duration limits

Practical Note

- Use lowest effective dose - Avoid prolonged routine prescribing when short-term use is enough - Short-term use preferred; prolonged use ↑ tardive dyskinesia risk - Chronic therapy should be exceptional, monitored, and indication-specific

Warnings

Clinical warnings

  • Duration / long-term: - Short-term use preferred - Prolonged use increases tardive dyskinesia risk - Chronic therapy should be exceptional, monitored, and indication-specific
  • Acute dystonia / akathisia (can occur early)
  • Tardive dyskinesia with prolonged use
  • Sedation / fatigue
  • Diarrhea
  • Parkinsonism worsening
  • Neuroleptic malignant syndrome (rare but serious)

Contraindications

  • Mechanical GI obstruction / perforation / GI bleeding where prokinetic effect is unsafe
  • Pheochromocytoma
  • Known seizure disorder in worsening context / significant EPS sensitivity when clinically relevant
  • Known hypersensitivity

Drug interactions (high-impact)

  • Other dopamine antagonists / antipsychotics → ↑ EPS risk
  • Sedatives / CNS depressants → additive sedation
  • Serotonergic agents or other QT-risk drugs — assess combined risk when clinically relevant (not exhaustive here)
  • Levodopa / dopamine agonists → antagonized dopaminergic effect

Special populations

Pediatrics

Specialist / weight-based / protocol-driven only

Pregnancy

Pregnancy: - Use according to indication and risk–benefit; follow current labeling and OB/pharmacy guidance Parkinsonism / movement disorders: - Avoid or use extreme caution (EPS worsening)

Lactation

Follow product labeling and specialist guidance

Renal impairment

Dose reduction required / consider lower exposure; half-life prolongs in renal impairment.

Hepatic impairment

Renal clearance dominant for parent drug; combined severe hepatic + renal impairment: follow labeling / specialist.

Elderly

Higher EPS and sedation risk.

Administration

- PO / IV / IM per indication - Slow IV push / controlled rate where protocol specifies — may reduce acute restlessness / akathisia in some patients - Practical route choice follows indication and monitoring capability

Monitoring

  • Monitor: - Symptom response - EPS (restlessness, dystonia, rigidity) - Sedation / mental status - Renal function if ongoing use
  • Recheck: - After repeated dosing - If therapy extends beyond a short course — reassess benefit vs neurologic risk at 48–72h windows; do not continue blindly as chronic PRN
  • Hold if:
    - Dystonia / akathisia / other significant EPS
    - Excess sedation
    - Suspected tardive dyskinesia or severe neurologic adverse effect

Overdose / toxicity

Clinical Picture

Sedation Agitation / EPS Autonomic / neurologic symptoms (severe cases)

Immediate Actions

Stop drug Supportive care Treat severe EPS per protocol (e.g., anticholinergic for dystonia per local guideline)

Antidote

No specific antidote

Decontamination

Acute overdose: poison center / supportive pathway per local protocol.

Escalation

Severe EPS, altered mental status, or autonomic instability → escalate per ED/ICU and neurology pathways.

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield

  • Excellent short-term antiemetic / migraine adjunct
  • Not a harmless routine PRN if repeatedly prescribed without reassessment

Clinical

  • If restlessness appears after dosing, think akathisia
  • In gastroparesis, reassess benefit regularly; avoid casual long-term continuation

Safety

  • Biggest error = prolonged use without reviewing neurologic risk

Pharmacokinetics

- Renal clearance important (dose adjustment in impairment) - Shorter-term antiemetic / prokinetic clinical effect than half-life alone implies for chronic risk (tardive dyskinesia tracks exposure duration)

Mechanism of action

- Dopamine antagonism (notably D2) with prokinetic upper GI effects

Common brand names

Saudi Arabia

Primperan, Plasil

Global

Reglan, Maxolon, Metoclopramide, (placeholder — verify local formulation)

Common trade names are curated examples only — formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

Global data (no country-specific data available)

  • Follow local antimicrobial stewardship policy, hospital formulary, and national resistance guidance.
  • Confirm dosing, stock, and restrictions with institutional pharmacy and current product labeling.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • AHS / migraine adjunct care references (regional)
  • ACG / gastroparesis management guidance (where applicable)
  • FDA / SFDA product labeling (EPS, duration limits, renal dosing)