Metoclopramide Accord (Metoclopramide Hydrochloride Anhydrous)

Metoclopramide is used to treat disorders of the gastrointestinal tract and nausea pathways.

• Nausea and vomiting (including chemotherapy‑induced): reduces the frequency and severity of nausea and vomiting episodes.
• Gastroparesis: enhances gastric emptying and relieves associated symptoms such as early satiety and bloating.
• Gastro‑oesophageal reflux disease (GERD): improves lower esophageal sphincter tone and decreases reflux episodes.
• Post‑operative nausea and vomiting: prevents nausea and vomiting following surgical procedures.

• Metoclopramide exerts its effect by selectively antagonizing dopamine D2 receptors in the chemoreceptor trigger zone and throughout the gastrointestinal tract, which diminishes the emetic signal. Concurrently, it stimulates 5‑HT4 receptors, enhancing acetylcholine release and promoting coordinated gastrointestinal motility. The combined dopaminergic blockade and serotonergic agonism accelerate gastric emptying and increase lower esophageal sphincter pressure, thereby reducing nausea and reflux.

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

Common Side Effects

• Drowsiness: feeling of sleepiness or reduced alertness.
• Fatigue: general lack of energy.
• Restlessness: inner sense of agitation or inability to stay still.
• Dry mouth: reduced salivation causing throat discomfort.

Serious or Rare Side Effects

• Extrapyramidal reactions: involuntary muscle movements or dystonia.
• Tardive dyskinesia: persistent, potentially irreversible facial or limb movements.
• Neuroleptic malignant syndrome: life‑threatening reaction with fever and muscle rigidity.
• Severe depression or suicidal thoughts: marked mood changes requiring immediate medical attention.

Before prescribing Metoclopramide, clinicians should evaluate several safety considerations.

• Assess renal function: dose adjustment may be needed in impaired clearance.
• Monitor for extrapyramidal symptoms: watch for muscle rigidity, tremor or abnormal movements.
• Avoid in patients with known hypersensitivity: discontinue if allergic reactions occur.
• Use caution in the elderly: increased susceptibility to central nervous system effects.
• Review concomitant CNS‑active drugs: potential additive sedation or movement disorders.
• Store at room temperature: keep in the original container, protect from moisture and light.

Metoclopramide can interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Antipsychotics (e.g., haloperidol): may counteract each other's effects and increase movement disorders.
• MAO inhibitors: risk of hypertensive crisis and serotonin syndrome.
• CYP2D6 inhibitors (e.g., quinidine): increase metoclopramide plasma levels.

Moderate Interactions (Monitor Closely)

• Opioids: additive central nervous system depression and reduced gastrointestinal motility.
• SSRIs or SNRIs: heightened risk of serotonin syndrome.