Metoclopramide Sandoz (Metoclopramide)

Metoclopramide is a dopamine antagonist used to treat conditions involving nausea, vomiting and delayed gastric emptying.

• Nausea and vomiting: reduces the frequency and severity of acute and chronic nausea and vomiting.
• Post‑operative nausea and vomiting: prevents and treats nausea after surgical procedures.
• Gastroparesis: enhances gastric motility and improves symptoms of delayed gastric emptying.
• Gastro‑oesophageal reflux disease (GERD): may lessen reflux symptoms by promoting gastric emptying.

• Metoclopramide acts as a competitive antagonist at dopamine D2 receptors in the chemoreceptor trigger zone, reducing the stimulus for nausea and vomiting. It also blocks peripheral 5‑HT3 receptors and increases acetylcholine release in the gastrointestinal tract, which enhances coordinated smooth‑muscle contractions and accelerates gastric emptying. The combined central and peripheral actions result in both antiemetic and gastro‑prokinetic effects, making it useful in postoperative settings and in disorders of gastric motility.

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

Common Side Effects

• Drowsiness: mild sedation or fatigue that may affect daily activities.
• Diarrhea: loose stools or increased frequency of bowel movements.
• Restlessness: feeling of inner tension, often described as akathisia.
• Dry mouth: reduced salivation leading to a parched sensation.

Serious or Rare Side Effects

• Extrapyramidal symptoms: muscle rigidity, tremor, dystonia, especially with higher doses or rapid escalation.
• Tardive dyskinesia: potentially irreversible involuntary movements after prolonged therapy.
• Neuroleptic malignant syndrome: rare life‑threatening reaction with fever, muscle breakdown and autonomic instability.
• Hyperprolactinemia: elevated prolactin levels causing galactorrhea or menstrual disturbances.

When prescribing Metoclopramide, clinicians should consider several safety precautions.

• Renal impairment: dose may need adjustment in patients with reduced kidney function.
• Elderly patients: increased risk of extrapyramidal reactions; use lowest effective dose.
• Pregnancy: safety not established; avoid unless benefit outweighs risk.
• Breastfeeding: drug excreted in milk; assess risk before use.
• Concomitant CNS depressants: may enhance drowsiness or sedation.
• Store at ambient temperature: keep below 25 °C, in original container, protected from moisture.

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

Major Interactions (Avoid)

• Antipsychotics (e.g., haloperidol, chlorpromazine): additive dopamine antagonism may increase risk of severe extrapyramidal symptoms.
• CYP2D6 substrates (e.g., codeine, tramadol): Metoclopramide may inhibit metabolism, raising plasma levels of these drugs.

Moderate Interactions (Monitor Closely)

• Serotonergic agents (e.g., SSRIs, triptans): combined effect may raise risk of serotonin syndrome.
• Anticholinergic drugs (e.g., atropine): may reduce pro‑kinetic benefit of Metoclopramide.
• Diuretics (e.g., furosemide): may enhance risk of electrolyte disturbances.