Drug reference

Metoclopramide hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 474, 475

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Symptomatic treatment of nausea and vomiting including that associated with acute migraine | Delayed (but not acute) chemotherapy-induced nausea and vomiting| Radiotherapy-induced nausea and vomiting | Prevention Nervous system of postoperative nausea and vomiting ▶BY MOUTH, OR BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION ▶Adult (body-weight up to 60 kg): Up to 500 micrograms/kg daily in 3 divided doses, when administered by slow intravenous injection, to be given over at least 3 minutes ▶Adult (body-weight 60 kg and above): 10 mg up to 3 times a day, when administered by slow intravenous injection, to be given over at least 3 minutes Hiccup in palliative care ▶BY MOUTH, OR BY INTRAMUSCULAR INJECTION, OR BY SUBCUTANEOUS INJECTION ▶Adult: 10 mg every 6–8 hours Nausea and vomiting in palliative care ▶BY MOUTH ▶Adult: 10 mg 3 times a day ▶BY SUBCUTANEOUS INFUSION ▶Adult: 30–100 mg/24 hours Acute migraine ▶BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: 10 mg for 1 dose, to be administered as soon as migraine symptoms develop; intravenous injection to be given over at least 3 minutes l UNLICENSED USE g Metoclopramide is used for the treatment of acute migraine, h but is not licensed for this indication.

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Contra Indications

3–4 days after gastrointestinal surgery. epilepsy. gastro-intestinal haemorrhage. gastro- intestinal obstruction. gastro-intestinal perforation. phaeochromocytoma

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Cautions

Asthma. atopic allergy. bradycardia. cardiac conduction disturbances. children. elderly. may mask underlying disorders such as cerebral irritation. Parkinson’s disease. uncorrected electrolyte imbalance. young adults CAUTIONS, FURTHER INFORMATION ▶Elderly Prescription potentially inappropriate (STOPP criteria) in patients with parkinsonism (risk of exacerbating parkinsonian symptoms). See also Prescribing in the elderly p. 33.

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Prescribing And Dispensing Information

Palliative care For further information on the use of metoclopramide hydrochloride in palliative care, see www.medicinescomplete.com/#/content/palliative/ metoclopramide.

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Safety

Important Safety Information

MHRA/CHM ADVICE—METOCLOPRAMIDE: RISK OF NEUROLOGICAL ADVERSE EFFECTS—RESTRICTED DOSE AND DURATION OF USE (AUGUST 2013) The beneﬁts and risks of metoclopramide have been reviewed by the European Medicines Agency’s Committee on Medicinal Products for Human Use, which concluded that the risk of neurological effects such as extrapyramidal disorders and tardive dyskinesia outweigh the beneﬁts in long-term or high-dose treatment. To help minimise the risk of potentially serious neurological adverse effects, the following restrictions to indications, dose, and duration of use have been made: . In adults over 18 years, metoclopramide should only be used for prevention of postoperative nausea and vomiting, radiotherapy-induced nausea and vomiting, delayed (but not acute) chemotherapy-induced nausea and vomiting, and symptomatic treatment of nausea and vomiting, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics); . Metoclopramide should only be prescribed for short- term use (up to 5 days); . Usual dose is 10 mg, repeated up to 3 times daily; max. daily dose is 500 micrograms/kg; . Intravenous doses should be administered as a slow bolus over at least 3 minutes; . Oral liquid formulations should be given via an appropriately designed, graduated oral syringe to ensure dose accuracy. This advice does not apply to unlicensed uses of metoclopramide (e.g. palliative care).

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Interactions

→Appendix 1: metoclopramide

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Side Effects

GENERAL SIDE-EFFECTS ▶Common or very common Asthenia. depression. diarrhoea . drowsiness. hypotension. menstrual cycle irregularities. movement disorders. parkinsonism ▶Uncommon Arrhythmias. hallucination. hyperprolactinaemia. level of consciousness decreased ▶Rare or very rare Confusion. galactorrhoea. seizure ▶Frequency not known Atrioventricular block. blood disorders. cardiac arrest. gynaecomastia. hypertension. neuroleptic malignant syndrome. QT interval prolongation. shock. syncope. tremor SPECIFIC SIDE-EFFECTS ▶With parenteral use Anxiety. dizziness. dyspnoea. oedema. skin reactions. visual impairment SIDE-EFFECTS, FURTHER INFORMATION Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young (especially girls and young women) and the very old; they usually occur shortly after starting treatment with metoclopramide and subside within 24 hours of stopping it. Injection of an antiparkinsonian drug such as procyclidine will abort dystonic attacks.

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Pregnancy

Not known to be harmful.

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Breast Feeding

Small amount present in milk; avoid.

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Hepatic Impairment

Manufacturer advises caution in severe impairment (risk of accumulation). Dose adjustments Manufacturer advises dose reduction of 50% in severe impairment.

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Renal Impairment

Dose adjustments Avoid or use small dose in severe impairment; increased risk of extrapyramidal reactions.

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Dose and formulations

Directions For Administration

Oral liquid preparation to be given via a graduated oral dosing syringe.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral solution Solution for injection ▶Metoclopramide hydrochloride (Non-proprietary) Metoclopramide hydrochloride 5 mg per 1 ml Metoclopramide 10mg/2ml solution for injection ampoules | 5 ampoule P £1.31– £15.00 | 10 ampoule P £25.00 DT = £2.88 ▶Maxolon (Advanz Pharma) Metoclopramide hydrochloride 5 mg per 1 ml Maxolon High Dose 100mg/20ml solution for injection ampoules | 10 ampoule P £26.68 Oral solution ▶Metoclopramide hydrochloride (Non-proprietary) Metoclopramide hydrochloride 1 mg per 1 ml Metoclopramide 5mg/5ml oral solution sugar-free | 150 ml P £19.79 DT = £19.79 Tablet ▶Metoclopramide hydrochloride (Non-proprietary) Metoclopramide hydrochloride 10 mg Metoclopramide 10mg tablets | 28 tablet P £1.80 DT = £0.88 ▶Maxolon (Advanz Pharma) Metoclopramide hydrochloride 10 mg Maxolon 10mg tablets | 84 tablet P £5.24 Combinations available: Paracetamol with metoclopramide, p. 497 ANTIEMETICS AND ANTINAUSEANTS › NEUROKININ RECEPTOR ANTAGONISTS

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Clinical care

Patient And Carer Advice

Counselling on use of pipette advised with oral solution.

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Dose text by age group

Adult (body-weight up to 60 kg)

Up to

First-line fragment. Read the complete Indications and Dose section above.

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Adult (body-weight 60 kg and above)

10 mg up to 3 times

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg every 6–8 hours

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg 3 times a day

First-line fragment. Read the complete Indications and Dose section above.

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Adult

30–100 mg/24 hours

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg for 1 dose, to be administered as soon as

First-line fragment. Read the complete Indications and Dose section above.

PDF page 474

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Metoclopramide hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 474, 475

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 474

Contra Indications

3–4 days after gastrointestinal surgery. epilepsy. gastro-intestinal haemorrhage. gastro- intestinal obstruction. gastro-intestinal perforation. phaeochromocytoma

PDF page 474

Cautions

PDF page 474

Prescribing And Dispensing Information

Palliative care For further information on the use of metoclopramide hydrochloride in palliative care, see www.medicinescomplete.com/#/content/palliative/ metoclopramide.

PDF page 474

Safety

Important Safety Information

PDF page 474

Interactions

→Appendix 1: metoclopramide

PDF page 474

Side Effects

PDF page 474

Pregnancy

Not known to be harmful.

PDF page 474

Breast Feeding

Small amount present in milk; avoid.

PDF page 474

Hepatic Impairment

Manufacturer advises caution in severe impairment (risk of accumulation). Dose adjustments Manufacturer advises dose reduction of 50% in severe impairment.

PDF page 474

Renal Impairment

Dose adjustments Avoid or use small dose in severe impairment; increased risk of extrapyramidal reactions.

PDF page 474

Dose and formulations

Directions For Administration

Oral liquid preparation to be given via a graduated oral dosing syringe.

PDF page 474

Medicinal Forms

PDF pages 474, 475

Clinical care

Patient And Carer Advice

Counselling on use of pipette advised with oral solution.

PDF page 474

Dose text by age group

Adult (body-weight up to 60 kg)

Up to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 474

Adult (body-weight 60 kg and above)

10 mg up to 3 times

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg every 6–8 hours

First-line fragment. Read the complete Indications and Dose section above.

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Adult

10 mg 3 times a day

First-line fragment. Read the complete Indications and Dose section above.

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Adult

30–100 mg/24 hours

First-line fragment. Read the complete Indications and Dose section above.

PDF page 474

Adult

10 mg for 1 dose, to be administered as soon as

First-line fragment. Read the complete Indications and Dose section above.

PDF page 474

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.