METOCLOPRAMIDE

Children:  0.1-0.2 mg/kg/dose PO/IV/IM up to QID (Maximum:  0.5 mg/kg/24 hr).

Adults: 10-15 mg/dose PO/IV/IM QID.  

Children <6 years: 0.1 mg/kg/dose IV 15 min. prior to procedure.

Children 6-14 years old: 2.5-5 mg/dose IV 15 min. prior to procedure.

Children >14 years and Adults: 10 mg/dose IV 15 min. prior to procedure.

1mg/kg/dose IV/PO prior to chemotherapy, then 0.04 mg/kg/dose IV/PO Q6H (Maximum:  10 mg/dose).

Alternate dosing: 1 mg/kg IV/PO Q6H*

Children:  0.1-0.2 mg/kg/dose IV Q6-8H PRN. (Maximum 0.5 mg/kg/24 hr)

Children > 14 years and Adults: 10 mg/dose IV Q6-8H PRN

Health Canada has advised that metoclopramide be contraindicated in children less than 1 year and that the maximum daily dosage not exceed 0.5 mg/kg/24 hr, due to risk of extrapyramidal symptoms (EPS).  When given in high doses, administer diphenhydramine (1 mg/kg/dose) concurrently to prevent dystonic reactions.

For GE reflux, risk of adverse effects may outweigh benefits. If used, administer doses 30 minutes before meals and at bedtime.

Chronic tardive dyskinesia has been described with use of metoclopramide for longer than 3 months.

Contraindicated in GI obstruction, seizure disorder, pheochromocytoma, age less than 1 year, and with concurrent medications likely to cause extrapyramidal symptoms (EPS).

May affect cyclosporine, digoxin, and tacrolimus levels.  Do not use with MAO inhibitors.

Parenteral metoclopramide may be used to facilitate passage of GI tubes.

Metoclopramide is not first-line for chemotherapy induced nausea and vomiting. Consider if other agents contraindicated or not effective.