Metoclopramide

Should be taken on an empty stomach. Take 30 min before meals.

Gastrointestinal haemorrhage, perforation or mechanical obstruction; confirmed or suspected phaeochromocytoma or other catecholamine-releasing paragangliomas; seizure disorder (e.g. epilepsy), Parkinson's disease, history of neuroleptic or metoclopramide-induced tardive dyskinesia, known history of methaemoglobinaemia with metoclopramide or of nicotinamide adenine dinucleotide hydrogen (NADH)-cytochrome b₅ reductase deficiency. Children <1 year of age. Concomitant use with antipsychotics, levodopa or dopaminergic agonists.

Patient with underlying neurological conditions, Parkinson' s disease, cardiac conduction disturbances or sick sinus syndrome, hypertension, uncorrected electrolyte imbalance, bradycardia, heart failure with coexisting renal impairment, risk factors of fluid overload (e.g. HF, cirrhosis), history of atopy (including asthma), porphyria, diabetes, disorders associated with delayed gastric emptying, history of depression. CYP2D6 poor metabolisers. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause drowsiness, dizziness and involuntary movements, if affected, do not drive or operate machinery. Monitoring Parameters Monitor blood tests and for signs and symptoms of tardive dyskinesia, neuroleptic malignant syndrome, and extrapyramidal manifestations.

Significant: Dystonic reactions, akathisia, parkinsonian symptoms, tardive dyskinesia, methaemoglobinaemia, circulatory collapse, severe bradycardia, cardiac arrest, QT prolongation, sinus arrest, torsades de pointes. depression, suicidal ideation; gynaecomastia, galactorrhoea, amenorrhoea and impotence secondary to hyperprolactinaemia, Blood and lymphatic system disorders: Rarely, agranulocytosis, leucopenia, neutropenia, sulfhaemoglobinaemia. Cardiac disorders: Supraventricular tachycardia, acute CHF, AV block. Eye disorders: Visual disturbance. Gastrointestinal disorders: Diarrhoea, nausea, vomiting, bowel disturbance. General disorders and administration site conditions: Asthenia, fatigue. Hepatobiliary disorders: Rarely, hepatoxicity. Immune system disorders: Hypersensitivity, rarely, angioedema. Investigations: Increased plasma aldosterone levels. Metabolism and nutrition disorders: Fluid retention, porphyria. Nervous system disorders: Somnolence, restlessness, headache, dizziness, seizure, rarely, tremor. Psychiatric disorders: Insomnia. Rarely, anxiety, agitation, confusion, hallucinations. Renal and urinary disorders: Urinary incontinence or urgency. Reproductive system and breast disorders: Priapism. Respiratory, thoracic and mediastinal disorders: Bronchospasm, rarely, laryngospasm, laryngeal oedema. Skin and subcutaneous tissue disorders: Rarely, rash, urticaria. Vascular disorders: Hypotension (IV), hypertension, flushing.
Potentially Fatal: Rarely, neuroleptic malignant syndrome characterised by muscle rigidity, hyperthermia, altered consciousness, autonomic instability.

Additive sedative effects with CNS depressants (e.g. morphine derivatives, anxiolytics, H1-receptor blockers, sedative antidepressants, barbiturates, clonidine). Increased risk of extrapyramidal disorders with other neuroleptic agents or centrally-acting drugs (e.g. phenothiazines, tetrabenazine). May increase the risk of serotonin syndrome associated with serotonergic drugs (e.g. SSRIs). May decrease the bioavailability of digoxin. May increase the absorption of ciclosporin, aspirin and paracetamol. May prolong the duration of action of neuromuscular blocking agents (e.g. mivacurium, suxamethonium). Increased serum concentrations with strong CYP2D6 inhibitors (e.g. fluoxetine, paroxetine). Plasma concentrations of atovaquone may be reduced by metoclopramide. Increased risk of QT prolongation with other agents known to prolong QT interval (e.g. class IA and III antiarrhythmics, TCAs, macrolides, antipsychotics). May alter the effects of central stimulants (e.g. sympathomimetics. Increased risk of hypertension with MAO inhibitors. May diminish the effect of antidiabetic agents.

Antiemetics / GIT Regulators, Antiflatulents & Anti-Inflammatories

A03FA01 - metoclopramide ; Belongs to the class of propulsives. Used in the treatment of functional gastrointestinal disorders.