metoclopramide hydrochloride (redirected from Maxeran)

metoclopramide hydrochloride

[met′əklō′prəmīd]

a GI motility agent.

indications It is prescribed to stimulate motility of and increase the tone of gastric contractions of the upper GI tract and to prevent emesis.

contraindications A history of seizures; concomitant use of drugs that cause extrapyramidal reactions; pheochromocytoma; GI hemorrhage, obstruction, or perforation; or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse effects are extrapyramidal reactions, usually in children, and GI disturbances. Drowsiness and allergic reactions and rash also may occur.

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metoclopramide hydrochloride

Apo-Metoclop (CA), Maxeran (CA), Maxolon (UK), Nu-Metoclopramide (CA), Primperan (UK) Reglan

Pharmacologic class: Dopamine antagonist

Therapeutic class: Antiemetic, GI stimulant

Pregnancy risk category B

Action

Blocks dopamine receptors by disrupting CNS chemoreceptor trigger zone, increasing peristalsis and promoting gastric emptying

Availability

Injection: 5 mg/ml

Solution: 5 mg/5 ml

Solution (concentrated): 10 mg/ml

Tablets: 5 mg, 10 mg

⊘Indications and dosages

➣ To prevent chemotherapy-induced vomiting

Adults: 1 to 2 mg/kg I.V. 30 minutes before chemotherapy, then q 2 hours for two doses, then q 3 hours for three additional doses

➣ To facilitate small-bowel intubation; radiologic examination when delayed gastric emptying interferes

Adults and children older than age 14: 10 mg I.V. as a single dose

Children ages 6 to 14: 2.5 to 5 mg I.V. as a single dose

Children younger than age 6: 0.1 mg/kg I.V. as a single dose

➣ Diabetic gastroparesis

Adults: 10 mg P.O. 30 minutes before meals and at bedtime for 2 to 8 weeks. If patient can't tolerate P.O. doses, give same dosage I.V. or I.M.

➣ Gastroesophageal reflux

Adults: 10 to 15 mg P.O. 30 minutes before meals and at bedtime for up to 12 weeks. For prevention, single dose of 20 mg (some patients may respond to doses as small as 5 mg).

➣ Prevention of postoperative nausea and vomiting

Adults: 10 to 20 mg I.M. near end of surgical procedure. Repeat dose q 4 to 6 hours, as needed.

Dosage adjustment

• Renal impairment

Off-label uses

• Hiccups

Contraindications

• Hypersensitivity to drug
• Pheochromocytoma
• Parkinson's disease
• Suspected GI obstruction, perforation, or hemorrhage
• History of seizure disorders

Precautions

Use cautiously in:
• diabetes mellitus
• history of depression
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Mix oral solution with water, juice, carbonated beverage, or semisolid food (such as applesauce or pudding) just before administration.
• Give I.M. or direct I.V. without further dilution.
• Administer low doses (10 mg or less) by direct I.V. injection slowly over 2 minutes. (Rapid injection may cause intense anxiety and restlessness followed by drowsiness.)
• For I.V. infusion, dilute with 50 ml of 5% dextrose in 0.9% sodium chloride solution, 5% dextrose in 0.45% sodium chloride solution, or lactated Ringer's solution. Infuse over at least 15 minutes.

Route	Onset	Peak	Duration
P.O.	30-60 min	Unknown	1-2 hr
I.V.	1-3 min	Immediate	1-2 hr
I.M.	10-15 min	Unknown	1-2 hr

Adverse reactions

CNS: drowsiness, restlessness, anxiety, depression, irritability, fatigue, lassitude, insomnia, tardive dyskinesia, parkinsonian-like reactions, extrapyramidal reactions, akathisia, dystonia

CV: hypertension, hypotension, arrhythmias

GI: nausea, constipation, diarrhea, dry mouth

GU: gynecomastia

Interactions

Drug-drug. Anticholinergics, opioids: antagonism of metoclopramide's GI motility effect

Antidepressants, antihistamines, other CNS depressants (such as opioids, sedative-hypnotics): additive CNS depression

Cimetidine, digoxin: decreased blood levels of these drugs

General anesthestics: exaggerated hypotension

Haloperidol, phenothiazines: increased risk of extrapyramidal reactions

Levodopa: decreased metoclopramide efficacy

MAO inhibitors: increased catecholamine release

Drug-diagnostic tests. Aldosterone, prolactin: increased levels

Drug-behaviors. Alcohol use: increased blood alcohol level, increased CNS depression

Patient monitoring

• Monitor blood pressure during I.V. administration.
• Stay alert for depression and other adverse CNS effects.
☞ Watch for extrapyramidal reactions, which usually occur within first 24 to 48 hours of therapy. To reverse these symptoms, give diphenhydramine 50 mg I.M. or benztropine 1 to 2 mg I.M., as prescribed.
• Check for development of parkinsonian-like symptoms, which may occur within first 6 months of therapy and usually subside within 2 to 3 months after withdrawal.
• With long-term use, assess patient for tardive dyskinesia.
• In diabetic patient, stay alert for gastric stasis. Insulin dosage may need to be adjusted.

Patient teaching

• Tell patient to take 30 minutes before meals.
• Instruct patient to report involuntary movements of face, eyes, or limbs.
• Caution patient to avoid driving and other hazardous activities until drug's effects are known.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.