METOCLOPRAMIDE HYDROCHLORIDE

Maxolon

 Reviewed by Dorothy Cooper
September 1996
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

  1. 0.03-0.1 mg/kg/dose by slow IV infusion over 30 minutes, PO every 6-8 hours.
  2. Maximum daily dosage 0.5 mg/kg/day.

Indications

  1. Impaired gastric emptying and gastrointestinal motility.
  2. Gastroesophageal reflux.

Contraindications and Precautions

  1. Known hypersensitivity to metoclopramide.
  2. Pheochromocytoma (may precipitate hypertensive crisis).
  3. Caution in neonates with hepatic or renal impairment.
  4. Caution in neonates with conditions in which stimulation of gastric motility may be hazardous (gastrointestinal haemorrhage, mechanical obstruction and/or perforation).
  5. Concurrent use with narcotic may increase respiratory depression, decrease gastrointestinal motility.

Clinical Pharmacology

Metoclopramide hydrochloride, a derivative of procainamide, stimulates motility of the upper gastrointestinal tract. Does not stimulate gastric, biliary or pancreatic secretions. Mechanism of action is unknown. Has both dopamine antagonistic activity and peripheral cholinergic effects. Also induces the release of prolactin.

Well absorbed from gastrointestinal tract. Marked variation in bioavailability as a consequence of very variable first pass metabolism. Large distribution volume (lipid soluble drug). Low binding (13-22%) to human plasma protein. Hepatic metabolism. Elimination via the kidney with significant fraction unchanged (40-50%). Rapid onset of action: 1-3 minutes following an IV dose (10-15 minutes IM; 30-60 minutes PO). Duration of action 1-2 hours.

Possible Adverse Effects

  1. Gastrointestinal disturbances (nausea, vomiting, diarrhoea).
  2. Hypotension.
  3. Cardiac arrhythmias.
  4. Restlessness, drowsiness, fatigue, anxiety, agitation.
  5. Dystonic reactions and extrapyramidal symptoms.

Special Considerations

  1. Therapy usually continued for 2-8 weeks.
  2. Side effects are usually mild, transient and reversible following discontinuation of the drug.
  3. May increase serum levels of aldosterone and prolactin
  4. Management of metoclopramide overdose and/or toxicity: discontinue metoclopramide, provide supportive therapy for side effects. May administer diazepam or benadryl for treatment oculogyric crisis.