Metoclopramida Medlink (Metoclopramide Hydrochloride Monohydrate)

Metoclopramide acts on dopaminergic pathways to control nausea and improve gastric motility. It is indicated for several clinical situations:

• Nausea and vomiting: reduces the frequency and severity of acute and chronic episodes.
• Post‑operative nausea and vomiting: prevents and treats nausea after surgical procedures.
• Gastroparesis: enhances gastric emptying in patients with delayed stomach emptying.
• Chemotherapy‑induced nausea: mitigates nausea associated with cytotoxic drug regimens.

• Metoclopramide antagonizes peripheral and central dopamine D2 receptors, blocks serotonin 5‑HT3 receptors, and agonises 5‑HT4 receptors. This combined activity increases gastrointestinal smooth‑muscle tone, accelerates gastric emptying, and suppresses the chemoreceptor trigger zone, thereby reducing nausea and vomiting.

Metoclopramide may cause a range of adverse reactions. Patients should be informed of both common and serious possibilities.

Common Side Effects

• Drowsiness: mild sedation that may affect alertness.
• Fatigue: generalized feeling of tiredness.
• Restlessness: inner sense of unease or agitation.
• Dizziness: light‑headed sensation, especially when standing quickly.
• Headache: mild to moderate cranial pain.
• Diarrhoea: loose stools occurring after administration.

Serious or Rare Side Effects

• Extrapyramidal symptoms: involuntary muscle movements or rigidity.
• Tardive dyskinesia: persistent involuntary facial movements with long‑term use.
• Neuroleptic malignant syndrome: life‑threatening hyperthermia and muscle rigidity.
• Depression or suicidal thoughts: mood changes requiring immediate evaluation.
• Anaphylaxis: severe allergic reaction with rash, swelling, and breathing difficulty.

Metoclopramide requires careful assessment before use to minimise risks.

• Neurological monitoring: watch for extrapyramidal signs, especially in the elderly.
• Cardiac caution: avoid in patients with known arrhythmias or prolonged QT interval.
• Renal function: adjust use in severe renal impairment.
• Hypersensitivity: discontinue if allergic reactions such as rash or angio‑edema occur.
• Pregnancy and lactation: reserve for situations where benefit outweighs potential risk.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Metoclopramide can interact with several drug classes, requiring vigilance.

Major Interactions (Avoid)

• MAO inhibitors: risk of hypertensive crisis and serotonin syndrome.
• Other dopamine antagonists (e.g., antipsychotics): additive extrapyramidal effects.
• Serotonergic agents (e.g., SSRIs, triptans): increased chance of serotonin syndrome.

Moderate Interactions (Monitor Closely)

• CNS depressants (e.g., benzodiazepines, alcohol): enhanced sedation.
• Antihistamines: may increase drowsiness.
• Anticholinergics: could reduce gastrointestinal motility benefits.
• Opioids: potential for additive nausea control but monitor for sedation.
• CYP2D6 inhibitors: may raise metoclopramide plasma levels.