Today's med: Metoclopramide (met oh KLOE pra mide)
(brand names: Metozolv ODT, Reglan)
Diphenhydramine, Lorazepam, Haloperidol,Meclozine, Chlorpromazine, Mirtazapine,Droperidol, Tetrahydrocannabinol,Granisetron, Aprepitant,Trimethobenzamide, Meclizine hydrochloride, Dolasetron, Metoclopramide hydrochloride, Trimethobenzamide Hydrochloride
Indications:
I.V., I.M.: Symptomatic treatment of diabetic gastroparesis; postpyloric placement of enteral feeding tubes; prevention and/or treatment of nausea and vomiting associated with chemotherapy, or postsurgery; to stimulate gastric emptying and intestinal transit of barium during radiological examination of the stomach/small intestine
Contraindications: Hypersensitivity to metoclopramide or any component of the formulation; GI obstruction, perforation or hemorrhage; pheochromocytoma; history of seizures or concomitant use of other agents likely to increase extrapyramidal reactions.
Actions: Blocks dopamine receptors and (when given in higher doses) also blocks serotonin receptors in chemoreceptor trigger zone of the CNS; enhances the response to acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions; increases lower esophageal sphincter tone
Adverse Effects: Most common S/E: diarrhea, drowsiness, restlessness. Sx of overdose: confusion and severe drowsiness.
Central nervous system: Drowsiness (~10% to 70%; dose related), acute dystonic reactions (<1% to 25%; dose and age related), fatigue (2% to 10%), lassitude (~10%), restlessness (~10%), headache (4% to 5%), dizziness (1% to 4%), somnolence (2% to 3%), akathisia, confusion, depression, hallucinations (rare), insomnia, neuroleptic malignant syndrome (rare), Parkinsonian-like symptoms, suicidal ideation, seizure, tardive dyskinesia
Dermatologic: Angioneurotic edema (rare), rash, urticaria
Endocrine & metabolic: Amenorrhea, galactorrhea, gynecomastia, hyperprolactinemia, impotence
Gastrointestinal: Nausea (4% to 6%), vomiting (1% to 2%), diarrhea
Genitourinary: Incontinence, urinary frequency
Hematologic: Agranulocytosis, leukopenia, neutropenia, porphyria
Hepatic: Hepatotoxicity (rare)
Ocular: Visual disturbance
Respiratory: Bronchospasm, laryngeal edema (rare), laryngospasm (rare)
Miscellaneous: Allergic reactions, methemoglobinemia, sulfhemoglobinemia
Warning: Tardive dyskinesia: [U.S. Boxed Warning]: May cause tardive dyskinesia, which is often irreversible; duration of treatment and total cumulative dose are associated with an increased risk. Therapy durations >12 weeks should be avoided (except in rare cases following risk:benefit assessment). Risk appears to be increased in the elderly, women, and diabetics; however, it is not possible to predict which patients will develop tardive dyskinesia. Therapy should be discontinued in any patient if signs/symptoms appear.
Standard Dosing:
Antiemetic (chemotherapy-induced emesis) (unlabeled): I.V.: 1-2 mg/kg 30 minutes before chemotherapy and every 2-4 hours (maximum: 5 doses/day); pretreatment with diphenhydramine will decrease risk of extrapyramidal reactions to this dosage
Postpyloric feeding tube placement: I.V.:
<6 years: 0.1 mg/kg as a single dose
6-14 years: 2.5-5 mg as a single dose
>14 years: Refer to adult dosing.
Adults: Gastroesophageal reflux: Oral: 10-15 mg/dose up to 4 times/day 30 minutes before meals or food and at bedtime; single doses of 20 mg are occasionally needed prior to provoking situations. Treatment >12 weeks is not recommended.
Diabetic gastroparesis:
Oral: 10 mg/dose up to 4 times/day 30 minutes before meals or food and at bedtime for 2-8 weeks
I.M., I.V. (for severe symptoms): 10 mg over 1-2 minutes; 10 days of I.V. therapy may be necessary before symptoms are controlled to allow transition to oral administration
Chemotherapy-induced emesis prophylaxis: I.V.: 1-2 mg/kg 30 minutes before chemotherapy and repeated every 2 hours for 2 doses, then every 3 hours for 3 doses (manufacturer labeling); pretreatment with diphenhydramine will decrease risk of extrapyramidal reactions
Alternate dosing: Note: Metoclopramide is considered an antiemetic with a low therapeutic index; use is generally reserved for agents with low emetogenic potential or in patients intolerant/refractory to first-line antiemetics.
Low-risk chemotherapy (unlabeled): I.V., Oral: 10-40 mg prior to dose, then every 4-6 hours as needed (NCCN Antiemesis guidelines, v.4.2009)
Breakthrough treatment (unlabeled): I.V., Oral: 10-40 mg every 4-6 hours (NCCN Antiemesis guidelines, v.4.2009)
Delayed-emesis prophylaxis (unlabeled): Oral: 20-40 mg/dose (or 0.5 mg/kg/dose) 2-4 times/day for 3-4 days (in combination with dexamethasone [ASCO guidelines, 2006])
Refractory or intolerant to antiemetics with a higher therapeutic index (unlabeled; Hesketh, 2008):
I.V.: 1-2 mg/kg/dose before chemotherapy and repeat 2 hours after chemotherapy
Oral: 0.5 mg/kg every 6 hours on days 2-4
Postoperative nausea and vomiting prophylaxis: I.M., I.V. (unlabeled route): 10-20 mg near end of surgery. Note:Guidelines discourage use of 10 mg metoclopramide as being ineffective (Gan, 2007); comparative study indicates higher dose (20 mg) may be efficacious (Quaynor, 2002)
Postpyloric feeding tube placement, radiological exam: I.V.: 10 mg as a single dose
Elderly: Initial: Dose at the lower end of the recommended range. Refer to adult dosing.
Drug
interactions: http://www.drugs.com/drug-interactions/metoclopramide.html
- 63 major drug interactions (255 brand and generic names)
- 516 moderate drug interactions (3169 brand and generic names)
- 9 minor drug interactions (54 brand and generic names)
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