Metoclopramid Polpharma (Metoclopramide Hydrochloride)

Metoclopramide is used to treat conditions that involve nausea, vomiting, and impaired gastrointestinal motility.

• Nausea and vomiting: reduces the frequency and severity of nausea and vomiting associated with various causes, including chemotherapy, migraine, and postoperative states.
• Gastroparesis: accelerates gastric emptying, thereby relieving early satiety, bloating, and nausea in patients with delayed gastric emptying.
• Gastro‑oesophageal reflux disease (GERD): improves gastric motility, which can lessen reflux episodes and associated heartburn in gastro‑oesophageal reflux disease.
• Post‑operative nausea: prevents or treats nausea and vomiting that commonly occur after surgical procedures, enhancing patient comfort and recovery.

• Metoclopramide blocks dopamine D2 receptors in the chemoreceptor trigger zone of the brain, reducing the stimulus for nausea and vomiting. It also antagonizes peripheral D2 receptors in the gastrointestinal tract, which increases acetylcholine release and promotes coordinated smooth‑muscle contractions, thereby enhancing gastric emptying and intestinal transit. The combined central anti‑emetic and pro‑kinetic actions make it effective for disorders where both nausea and delayed gastric motility are present.

Metoclopramide may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Drowsiness: feeling of sleepiness or reduced alertness.
• Fatigue: general tiredness or lack of energy.
• Restlessness (akathisia): inner sense of unease and need to move.
• Dry mouth: reduced salivation causing throat discomfort.

Serious or Rare Side Effects

• Extrapyramidal symptoms: involuntary muscle movements, especially of the face and neck.
• Tardive dyskinesia: persistent, potentially irreversible involuntary movements after long‑term use.
• Neuroleptic malignant syndrome: rare but life‑threatening reaction with fever, muscle rigidity, and autonomic instability.

When prescribing Metoclopramide, clinicians should consider several safety precautions to minimize risks.

• Assess renal and hepatic function: adjust use in patients with severe impairment.
• Monitor for extrapyramidal symptoms: watch for muscle rigidity, tremor, or abnormal movements.
• Use the lowest effective dose: limit duration to the shortest period necessary.
• Avoid in patients with known hypersensitivity to metoclopramide or other dopamine antagonists.
• Caution in pregnancy: limited data; weigh potential benefits against risks.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Metoclopramide can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• MAO inhibitors: concurrent use may cause hypertensive crises or severe reactions.
• CNS depressants (e.g., opioids, benzodiazepines): may enhance sedation and respiratory depression.
• Anticholinergic agents: may reduce the pro‑kinetic effect of metoclopramide.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): increase plasma concentrations, raising risk of side effects.

Moderate Interactions (Monitor Closely)

• Antidepressants (SSRIs, SNRIs): may increase risk of serotonin syndrome.
• Antihistamines: can potentiate drowsiness.
• Alcohol: may augment central nervous system depression.