Klometol (Metoclopramide Hydrochloride)

Metoclopramide acts on dopaminergic and serotonergic pathways to manage conditions associated with nausea, vomiting and delayed gastric emptying.

• Nausea and vomiting: reduces episodes of acute and chronic nausea and vomiting.
• Post‑operative nausea: prevents and treats nausea after surgery.
• Chemotherapy‑induced nausea: alleviates nausea caused by anticancer drugs.
• Gastroparesis: enhances gastric motility and accelerates gastric emptying.
• Gastro‑oesophageal reflux disease: reduces reflux symptoms by improving gastric clearance.

• Metoclopramide exerts its effect by competitively antagonizing dopamine D2 receptors in the chemoreceptor trigger zone and throughout the gastrointestinal tract, thereby reducing nausea signaling. It also blocks serotonin 5‑HT3 receptors and stimulates 5‑HT4 receptors, which together promote gastric smooth‑muscle contraction and accelerate gastric emptying. Additionally, the drug’s central dopaminergic blockade contributes to its antiemetic properties, while peripheral actions enhance upper gastrointestinal motility, facilitating the movement of contents from the stomach to the duodenum.

Metoclopramide may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Drowsiness or fatigue.
• Restlessness or agitation.
• Diarrhea or abdominal cramping.

Serious or Rare Side Effects

• Extrapyramidal reactions such as dystonia, akathisia or tardive dyskinesia.
• Neuroleptic malignant syndrome.
• Hyperprolactinemia leading to galactorrhea.
• Severe allergic reactions, including anaphylaxis.

When using Klometol, consider the following precautions.

• Assess renal function: adjust dose in patients with renal impairment.
• Monitor for extrapyramidal symptoms: observe for muscle rigidity, tremor or abnormal movements.
• Avoid in patients with gastrointestinal obstruction or perforation: contraindicated.
• Use with caution in the elderly: increased susceptibility to side effects.
• Pregnancy and lactation: use only if benefit outweighs potential risk, as safety data are limited.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Metoclopramide can interact with several medicines; review patient medication lists carefully.

Major Interactions (Avoid)

• MAO inhibitors: risk of hypertensive crisis.
• Antipsychotics (e.g., haloperidol): additive extrapyramidal risk.
• CYP2D6 inhibitors (e.g., fluoxetine): increased metoclopramide plasma levels.

Moderate Interactions (Monitor Closely)

• Opioids: may increase gastrointestinal side effects.
• SSRIs or SNRIs: potential for serotonin syndrome.
• Antihistamines: additive drowsiness.