Dose:   0.1 to 0.15 mg/kg/dose IV, PO

Frequency: Q 8 hours

Comments:  metoclopramide is used to improve gastric emptying and intestinal motility.  Metoclopramide is a derivative of procainamide that is well absorbed from the GI tract. It is a potent dopamine antagonist with both peripheral and central effects. It is a powerful central anti-emetic. Peripherally, it stimulates gastrointestinal smooth muscle. Though its mode of action is not completely understood, some of its effectiveness is due to the blockade of dopamine receptors which inhibit GI motility. Metoclopramide does not increase gastric acidity (Ramirez and Richter. Aliment Pharmacol Ther 1993; 7:5). Sankaran (Dev Pharmacol Ther 1982; 5:114) used metoclopramide to treat infants with feeding intolerance. These infants met fairly specific criteria before being enrolled in the study. All infants improved when given 0.033 mg iv q 8 hours and suffered recurrent symptoms when the medication stopped. No side effects were encountered during the two week trial. In using the drug for GE reflux, Blanchard (Clin Perinatol, 14:903, 1987) briefly note that it appears to be effective in some infants sufficient to justify "long-term" treatment. However they generally used higher doses (0.1 to 0.17 mg/kg/dose q 8 hours). They reported only that they did not see significant side effects from the medication. Finally, Tolia reported on a randomized, double-blind placebo crossover trial (Pediatr Res, 23:264A, 1988). Using a dose of 0.033 mg/kg q 8 hours no differences were noted between treated and placebo for weight gain, however infants who received the drug had improvement in symptoms and parameters measured during 8 hour esophageal pH monitoring. Because of adverse effects of the drug, the potential extrapyramidal side effects, and the availability of cisapride, the Working Group on Gastro-Oesophageal Reflux of the European Society of Paediatric Gastroenterology and Nutrition (Vandenplas. J Pediatr Gastroenterol Nutr 1994; 18:413) no longer recommends metoclopramide for treatment of GER.

Toxicity: The commonly reported side effects are nervousness, somnolence, dystonic reactions, and extrapyramidal symptoms such as torticollis, facial spasms, opisthotonus, and oculogyric crises.

Preparation:
IV: Metoclopramide (Reglan) is available in 2 ml preservative-free vials (5 mg/ml). Draw up 1 ml of the metoclopramide into a 12 cc syringe. Then draw up 9 ml of either NS, D5W, D5 0.45NS, or LR into the syringe. The concentration of the solution is 0.5 mg/ml. Protect from light. The 0.5 mg/ml solution is stable at room temperature for 24 hours. Infuse over 15 to 30 minutes.

PO: Metoclopramide (Reglan) is available in a 1 mg/ml syrup. Protect from light, store at room temperature. 

Compatibility: Compatible with TPN, no information about filter.   Also compatible with D5W, D5 with  saline, LR, normal saline, acyclovir, alprostadil, aminophylline, atropine, aztreonam, clindamycin,  dexamethasone, diphenhydramine, famotidine, fentanyl, filgrastim, fluconazole, heparin, hydrocortisone, insulin, lidocaine, magnesium sulfate, meropenem, midazolam, morphine, piperacillin-tazobactam, propofol, ranitidine, and zidovudine. It is incompatible with allopurinol, ampicillin, calcium gluconate, cephalothin, chloramphenicol, erythromycin, furosemide, penicillin G (potassium), and sodium bicarbonate.