Drug Trade Name: Reglan, Metozolv ODT Generic Name: Metoclopramide Introduction and quick information: Metoclopramide is a helpful

drug for the stimulation of gastrointestinal tract thus allowing easy passage of stomach content into intestines. This medication is available under different trade names that are Relgan, Metozolv, Mexalon and many more. Gastro esophageal Reflux Disease (GERD) is a situation in which stomach acid flow backwards causing heartburn and swelling in esophagus. Metoclopramide can treat GERD by maintaining the efficiency of lower esophageal sphincter responsible for the preventing acid reflux. Is it approved By FDA? FDA first approved Metoclopramide in the year 1979 on 7th of February for the treatment of problems related to gastrointestinal tract especially GERD. Usage and Benefits of Metoclopramide: A number of benefits are brought by Metoclopramide to the health of a patient being treated with this medication. These benefits involve-

Treatment of gastroparesis in diabetic patients Treatment of Gastro esophageal Reflux Disease (GERD) Metoclopramide for GRED- GRED is caused by reverse flow of acid present in stomach towards the esophagus. This causes sores and ulcers in the esophagus. The symptoms include heartburn, sour or acidic taste in the mouth, chest pain and feeling like choking. Metoclopramide treats GERD by contracting the muscles of lower esophageal sphincter thereby reducing chances of acid reflux as well as provide relief from the symptoms of GRED. Metoclopramide for Diabetic Gastroparesis- this problem occurs when patients suffering from type1 or type2 diabetes suffer from the delayed emptying of stomach into the intestine as a result of weakness of stomach nerves. Symptoms of this problem include heartburn, vomiting, loss of appetite, bloating, weight loss and many more. Metoclopramide treats this problem by causing relaxation of pyloric sphincter (opening between stomach and intestine) and blocks dopamine receptors to prevent vomiting or nausea sensations. Off-label use of Metoclopramide- off-label use of Metoclopramide involves following benefits that includeTreatment of morning sickness Stimulation of breast milk production Treatment of vomiting and nausea caused by migraines Metoclopramide Side Effects: The most common side-effects of Metoclopramide are listed below so that you can identify them easily and inform your doctor as soon as possible Jaundice Tremors Anxiety Uneven heartbeats Restless muscle movements High fever Sweating Confusion Suicidal thoughts Very stiff (rigid) muscles Depressed mood Hallucinations Agitation Swelling Headache Seizure (convulsions). Fluid retention Feeling restless

 Diarrhea Sleep problems (insomnia) Nausea or vomiting Unusual urinating. Changes in your menstrual periods If you are facing any other unusual change in your health condition then also inform your healthcare provider about the new side-effect and ask for the actual reason behind its existence. General recommended dosages of Metoclopramide: Dosages of Metoclopramide are prescribed according to the current medical condition of the patient and the problem for which he is taking this medication. The dosage strength may also need adjustments if the patient is using any other medication of same or different formulations. GRED can be treated with Metoclopramide dosage within 12 weeks if about 10 to 15 mg of the medication is taken four times a day but if symptoms of GRED occur in response to some specific food products then a single dose of 20mg at the time of meal can do the job for you. Taking 10mg of Metoclopramide four times a day can help you in getting rid of gastroparesis in case you are a diabetic patient. In case I miss the dose? In case of GRED, missing a dose is not an issue because it is taken generally at the time your body responds negatively to certain food products and causing occurrence of side-effects. But if you are taking it in a scheduled manner then stick to your schedule and skip the missed dose. But if you are suffering from diabetic gastroparesis then missing a dose can be harmful because it may lead to retention of food in the stomach thereby blocking the opening between stomach and intestine. Thus, in case of missed dose, take it at the moment you remember it but before the next scheduled dose. In case I take overdose? Overdose of Metoclopramide may lead to experience of side-effects that may include drowsiness, seizures, and lack of energy, headache, confusion and difficulty breathing. These side-effects can cause harm to your health and can totally vanish the beneficial affect caused to your body by Metoclopramide so far when taken in adequate amount. Thus, get instant medical attention and after that ask your doctor how you can get back to the medical condition you were in before taking overdose. Drug Interactions of Metoclopramide: Drug interactions of Metoclopramide are listed below-

Cyclosporine (Neoral, Gengraf, Sandimmune); Acetaminophen (Tylenol); Glycopyrrolate (Robinul); Urinary bladder medications like darifenacin (Enablex), oxybutynin (Oxytrol, Ditropan), or solifenacin (Vesicare); Digoxin (Lanoxin, digitalis); scopolamine (Transderm-Scop); Levodopa (Atamet, Sinemet, Parcopa, Larodopa); Insulin; Tetracycline (Brodspec, Tetracap, Sumycin, Ala-Tet, Panmycin); Atropine (Donnatal, and many more) benztropine (Cogentin) Mepenzolate (Cantil); methscopolamine (Pamine) dimenhydrinate (Dramamine), Bronchodilators like tiotropium (Spiriva) or ipratroprium (Atrovent) Psychiatric disorders medications like chlorpromazine (Thorazine), haloperidol (Haldol),), prochlorperazine (Compazine), thiothixene (Navane), and many more. Irritable bowel medications like dicyclomine (Bentyl), or propantheline (Pro-Banthine);

An MAO inhibitor such as furazolidone (Furoxone), phenelzine (Nardil), or tranylcypromine (Parnate); Interaction of these drugs with Metoclopramide should be checked prior to their usage along with Metoclopramide because their interaction may be harmful for the health of the patient. The above list is not complete thus doctors advice is recommended for checking out all the drugs you are using or planning to use. Life style and food habits you must follow when on Metoclopramide: Leading a healthy life is the best way to get quick and highly beneficial results. The lifestyle may include performing exercises that can lead to efficient digestion of food intake so that the probability of acid production in stomach reduces as well as the digested food gets easily passed from stomach to intestines. You can also avoid alcohol and other food products like spicy food that can enhance the production of acid in your body and also affects the efficacy of the Metoclopramide medication. You can consult your doctor for dietary instruction for better results. How safe is Metoclopramide for pregnant women or Nursing mothers? Metoclopramide is classified as a pregnancy category B drug by the FDA because no evidence of fetal harm is revealed in the animal studies and lack of controlled data on its effect on human pregnancy. Thus, it should be prescribed to a pregnant lady only if its benefits outweigh the associated risks. The American Academy of Pediatrics suggested taking effective cautions before using Metoclopramide because it secretes into human milk and considering its potential effects on the nervous system. Complications and Conditions possible due to prolonged use of Metoclopramide: Long-term use of Metoclopramide may cause uncontrollable muscle movements or tremors if an old person is taking this medication. Others can suffer the side-effects associated with it including nausea, vomiting, ulcers and sores in esophagus and many more symptoms. Stopping the Metoclopramide dosage is equally harmful because it can also cause harm to the health of the patient because of occurrence of withdrawal symptoms like nervousness, dizziness and headache. Thus, gradual decrease in dosing amount should be adopted before stopping it completely. Availability of Metoclopramide: Metoclopramide is available in the form of tablets as well as oral solution that can be injected also. All these formulations are available at a number of drug stores as well as government authorized health centers. Online option is also available if you are not able to go yourself to take the medication.

Brand Names: Apo-Metoclop, Clopra, Emex, Maxeran, Octamide, Octamide PFS, Reclomide, Reglan, Plasil Classifications: Therapeutic: antiemetics Indications Prevention of chemotherapy-induced emesis. Treatment of postsurgical and diabetic gastric stasis. Facilitation of small bowel intubation in radiographic procedures. Management of esophageal reflux. Treatment and prevention of postoperative nausea and vomiting when nasogastric suctioning is undesirable. Unlabeled uses: Treatment of hiccups. Adjunct management of migraine headaches. Mechanism of Action

Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying. Therapeutic Effects: Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Easier passage of nasogastric tube into small bowel. Contraindications/Precautions Contraindicated in: Hypersensitivity; Possible GI obstruction or hemorrhage; History of seizure disorders; Pheochromocytoma; Parkinsons disease. Use Cautiously in: History of depression; Diabetes (may alter response to insulin); Renal impairment (reduce dose in CCr <50 ml/min); OB, Lactation: Safety not established; Pedi: some syrup products contain benzoate, a metabolite of benzyl alcohol which can cause potentially fatal gasping syndrome in neonates. Prolonged clearance in neonates can result in high serum concentrations and increase the risk for methemoglobinemia. Side effects are more common in children especially extrapyramidal reactions; Geri: More susceptible to oversedation and extrapyramidal reactions. Adverse Reactions/Side Effects CNS: drowsiness, extrapyramidal reactions, restlessness, NEUROLEPTIC MALIGNANT SYNDROME, anxiety, depression, irritability, tardive dyskinesia. CV: arrhythmias (supraventricular tachycardia, bradycardia), hypertension, hypotension. GI: constipation, diarrhea, dry mouth, nausea. Endo: gynecomastia. Hemat: methemoglobinemia, neutropenia, leukopenia, agranulocytosis. Route/Dosage Prevention of Chemotherapy-Induced Vomiting PO, IV (Adults and Children): 12mg/kg 30 min before chemotherapy. Additional doses of 1 2mg/kg may be given q 24 hr, pretreatment with diphenhydramine will decrease the risk of extrapyramidal reactions to this dosage. Gastroesophageal Reflux PO, IM, IV (Adults): 1015 mg 30 min before meals and at bedtime (not to exceed 0.5 mg/kg/day).

A single dose of 20 mg may be given preventively. Some patients may respond to doses as small as 5mg. PO, IM, IV (Neonates, Infants, and Children): 0.40.8 mg/kg/day in 4 divided doses. Postoperative Nausea/Vomiting IM, IV (Adults and Children >14 yr): 10 mg at the end of surgical procedure, repeat in 68 hr if needed. IM, IV (Children <14 yr): 0.10.2 mg/kg/dose, repeat in 68 hr if needed. Nursing Management 1. Instruct patient to take metoclopramide as directed. Take missed doses as soon as remembered if not almost time for next dose. 2. Pedi: Unintentional overdose has been reported in infants and children with the use of metoclopramide oral solution. Teach parents how to accurately read labels and administer medication. 3. May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. 4. Advise patient to avoid concurrent use of alcohol and other CNS depressants while taking this medication. 5. Advise patient to notify health care professional immediately if involuntary movement of eyes, face, or limbs occurs.