Metoclopramide

What is Metoclopramide?

Metoclopramide is a medication that increases gastrointestinal motility (contractions of the stomach and small intestines) and also blocks the effect of a chemical known as dopamine, which can induce nausea through its actions on receptors in the brain. Having received its FDA approval in 1985, the drug is sold under the brand name Reglan and is available as either a standard or dissolvable tablet, in liquid form, or an injectable solution.

What is Metoclopramide used for?

Although Metoclopramide is primarily indicated for the treatment of gastrointestinal (GI) disorders such as acid reflux and a slow-moving GI tract (gastroparesis), it is also used to treat nausea and vomiting commonly associated with migraine headaches. Additionally, it can increase the efficacy of other medications used to treat migraines such as Topiramate and Propranolol.  Metoclopramide is commonly prescribed to prevent or treat nausea caused by chemotherapy, radiation therapy and surgical procedures.

How does Metoclopramide work?

Metoclopramide is classified as a dopamine antagonist, which works by blocking dopamine receptors found in a part of the brain known as the chemoreceptor trigger zone (CTZ). When the CTZ detects an irritant, it sends signals to a part of the brain known as the vomiting center.  This in turn sends signals to the gastrointestinal system which can lead to vomiting.  The CTZ itself can respond to external stimuli such as unpleasant odors and also responds to irritation in the GI tract.  Basically, by blocking the effect of dopamine on the CTZ, Metoclopramide can stop the chain of signalling leading to nausea and vomiting. 

Furthermore, an individual who is suffering from a migraine headache will often experience nausea and vomiting, and may therefore be unable to take the appropriate medications needed to treat the migraine.  Metoclopramide can be taken to alleviate nausea and vomiting prior to taking migraine medications, and can also help facilitate passage and absorption through the digestive system, thereby increasing the medications efficacy.

Where can I buy Metoclopramide?

Metoclopramide is a prescription medication and cannot be purchased over the counter in the United States. Medzino offers Metoclopramide in 10 mg strength and in quantities of 30 standard tablets. We are able to offer first and repeat prescriptions to patients, specifically for the reduction of nausea and vomiting that can accompany severe migraines. Our doctors will assess your symptoms through our online consultation service and subsequently individualize your treatment and dosage.

How long does Metoclopramide take to work?

Once ingested, Metoclopramide tablets typically begin to take effect after 30 to 60 minutes. Symptoms of nausea and vomiting should subside 1 to 3 days after starting the treatment.

Active ingredients

The active ingredient in Metoclopramide is metoclopramide hydrochloride.

Inactive ingredients

The inactive ingredients in Metoclopramide are magnesium stearate, cellulose, microcrystalline, mannitol and stearic acid.

Which ingredients can cause an allergic reaction?

In rare cases, some people might experience a severe allergic reaction to this medication. Facial swelling, hives, dizziness, chest tightness and trouble breathing are symptoms of a severe allergic reaction. If you notice these symptoms after taking metoclopramide, you should call for immediate medical attention. 

How to take Metoclopramide

Metoclopramide can be taken with or without food and should be swallowed with a drink of water. If you have difficulty swallowing the tablet whole, you may break it along the scored line.

Always take Metoclopramide as prescribed by your doctor, and be sure to follow the instructions on the patient information leaflet. Do not take more or less than the prescribed amount or for a longer duration than your doctor has ordered, as doing so may increase the chance of adverse side-effects.

How much Metoclopramide should I take?

For the symptomatic treatment of nausea and vomiting associated with acute migraines, a single 10 mg dose of Metoclopramide should be administered at the onset of  migraine symptoms.  The maximum daily dose should not exceed 30 mg.

In order to avoid an overdose, you must wait a minimum of 6 hours between each dose of Metoclopramide, even in cases of vomiting and rejection of the medication.

The above dosage and directions may need to be adjusted for older people or those with kidney and liver problems.  Metoclopramide is not recommended for use in children.

How long should I take Metoclopramide for?

In order to avoid serious side-effects and reactions, the maximum duration of treatment with Metoclopramide must be no more than 5 days at a time and overall treatment should not exceed 12 weeks.  If your symptoms persist or worsen, consult your doctor immediately.

How can I discontinue using Metoclopramide?

Continue taking Metoclopramide as your doctor has advised – even if you experience relief from your symptoms. If you want to discontinue your treatment, always speak with your doctor for direction on the best way to do so. You may experience withdrawal symptoms such as dizziness, nervousness, and headaches when you stop taking the medication.

What if I miss a dose of Metoclopramide?

If you forget to take a dose of Metoclopramide, take it as soon as you remember; however, if you are approaching your next scheduled dose (within less than 4 hours), skip the missed dose altogether. Do not double the dose to make up for one that you have missed.

What if I take too much Metoclopramide?

If you have taken more Metoclopramide tablets than prescribed, contact your doctor or pharmacist immediately. Symptoms you may experience from an overdose include:

• Uncontrollable movements
• Drowsiness
• Unconsciousness
• Confusion
• Hallucinations
• Heart rhythm disturbances

Your doctor may prescribe you additional medication for the above symptoms, if necessary.

What are the side-effects of Metoclopramide?

Although Metoclopramide is generally well-tolerated when taken in low doses over a short period, it may trigger certain side-effects in long-term users or those who ingest it in high doses.

The most common side-effect of Metoclopramide is drowsiness, affecting more than 1 in 10 users, and should not be a cause for concern.

Other common side-effects include (affecting up to 1 in 10 people):

• Depression
• Uncontrollable movements
• Shaking/trembling
• Restlessness
• Diarrhea
• Low blood pressure
• Feeling weak

Uncommon side-effects include (affecting up to 1 in 100 people):

• Increased production of prolactin (a hormone produced in the brain), which may cause milk production in both men and non-nursing women.
• Irregular periods
• Hallucinations
• Decreased levels of consciousness
• Slowed heartbeat

Metoclopramide, in extremely rare cases, may cause a serious condition known as Neuroleptic Malignant Syndrome (NMS). Seek medical attention immediately if you experience symptoms including:

• Muscle stiffness
• Fever
• Severe confusion
• Sweating
• Fast/irregular heartbeat

Always inform your doctor if your symptoms persist or worsen, including any that are not listed above.

Precautions

Prior to taking Metoclopramide, you must inform your doctor of your full medical history, including:

• Allergies to any of the active or inactive ingredients in Metoclopramide, or any other medication
• A history of abnormal heartbeats or a heart condition known as “long QT syndrome”
• Kidney or liver problems
• Neurological (brain) disorders
• Low levels of salt in the blood
• Intolerance to sugars such as lactose

Treatment with Metoclopramide may cause a condition known as tardive dyskinesia, a disease that triggers abnormal and uncontrollable muscle movements in the face and body, and is often irreversible – even if the drug is stopped. Patients who take the medication in high doses and over prolonged periods are at a greater risk of developing this condition, as are children and older adults. Discontinue usage and call your doctor immediately if you experience any involuntary body movements such as sticking out of the tongue, puffing cheeks, lip smacking or chewing.

As Metoclopramide may cause dizziness and/or drowsiness in some users, it is advised not to drive, operate heavy tools or machinery, or engage in any activities that require alertness until the effects have completely worn off.

Consuming alcohol during treatment with Metoclopramide may increase the drugs sedative effects. It is therefore advisable to avoid alcohol intake when taking Metoclopramide.

For women who are pregnant, or planning to become pregnant, it is important to always seek your doctor’s advice prior to taking Metoclopramide. Although the medication has no known effects on the developing foetus, it should only be taken if considered essential.

Metoclopramide is not recommended for women who are breastfeeding as the drug passes into breast milk in small amounts and may have an effect on the baby.

Contraindications

Metoclopramide is not recommended for those who have, or have previously had:

• An allergic reaction to any of the active or inactive ingredients in Metoclopramide, or any other medication.
• Any type of recent surgery on the gut
• A blockage in the intestines or stomach
• Bleeding from anywhere in the gastrointestinal tract
• Breast cancer
• High blood pressure
• Kidney problems
• Parkinson’s disease
• Liver problems
• Seizures
• Blood disorders
• A tumor of the adrenal gland (phaeochromocytoma)

Drug Interactions

When certain drugs are taken in combination, their efficacy may be reduced, or cease completely.  Certain combinations can also produce serious adverse side-effects. Before beginning treatment with Metoclopramide, you must inform your doctor of all medications you are currently taking, including any prescription and over-the-counter drugs, as well as any vitamins or herbal supplements; particularly:

• Medication for Parkinson’s disease
• Medication for stomach cramps or spasms
• Medication for heart failure
• Morphine or other drugs to treat severe pain
• Sedatives
• Anti-psychotic drugs
• Antidepressants
• Muscle relaxants

If it is determined that treatment with Metoclopramide is not appropriate for you, consult your doctor or pharmacist about alternative medication for the symptoms of nausea and/or vomiting associated with migraines.

Alternative Treatment Options

While there are many treatment options available for treating nausea and vomiting, not all are intended for nausea and vomiting related to migraines.

The most effective remedy will depend on the severity of your symptoms, your medical history, and your response to the medication. Listed below are a few viable options; however, speak with your doctor for a comprehensive list of alternative treatments, and to establish which one will work best for you.

Promethazine

This is an antihistamine drug which works by blocking natural substances in the brain that trigger the sensation of nausea. However, the medication may not be suited to those who suffer from certain conditions including asthma, low or high blood pressure, heart disease, or a weak immune system.

Chlorpromazine

This is an antipsychotic drug which is also licenced for treating and controlling nausea and vomiting. It works by restoring balance in the natural chemicals found in the brain; however; it may induce side-effects similar to that of Metoclopramide including uncontrollable body movements.

Prochlorperazine

Similar to Metoclopramide, this drug also helps relieve nausea and vomiting by interacting with dopamine receptors in the brain. Its common side-effects include confusion, dizziness, digestive upset and excitability.

Nabilone

This drug is derived from cannabis and can be used to treat sickness that cannot be controlled by other antiemetic medication. While the drug is effective, it may cause drowsiness or dizziness in some users, which may last for a few days after you have stopped taking it.