Metoclopramide Viatris (Metoclopramide Hydrochloride)

Metoclopramide acts on gastrointestinal motility and central emetic pathways, making it useful for several conditions.

• Nausea and vomiting: reduces frequency and severity of acute and chemotherapy‑induced episodes.
• Gastroparesis: improves gastric emptying and alleviates related symptoms.
• Gastro‑oesophageal reflux disease (GERD): enhances lower esophageal sphincter tone and reduces reflux episodes.
• Migraine‑associated nausea: provides anti‑emetic relief during migraine attacks.

• Metoclopramide blocks dopamine D2 receptors in the chemoreceptor trigger zone and gastrointestinal smooth muscle, while also antagonising serotonin 5‑HT3 receptors and agonising 5‑HT4 receptors. This combined action increases the tone of the upper gastrointestinal tract, accelerates gastric emptying, and suppresses the central vomiting reflex, resulting in improved motility and anti‑emetic effects.

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

Common Side Effects

• Drowsiness: feeling unusually sleepy or fatigued.
• Restlessness: a sense of inner tension or inability to stay still.
• Diarrhoea: loose, frequent stools.
• Headache: mild to moderate head pain.

Serious or Rare Side Effects

• Tardive dyskinesia: involuntary, repetitive movements, potentially irreversible.
• Neuroleptic malignant syndrome: high fever, muscle rigidity, autonomic instability.
• Severe allergic reaction: rash, swelling, difficulty breathing.
• Cardiac arrhythmia: abnormal heart rhythm, especially in patients with pre‑existing heart disease.

Before prescribing Metoclopramide, clinicians should consider several safety measures.

• Renal function assessment: adjust use in patients with impaired clearance.
• Extrapyramidal monitoring: watch for muscle rigidity or tremor.
• Duration limitation: avoid prolonged therapy beyond recommended periods.
• Concomitant CNS depressants: use cautiously to prevent excessive sedation.
• Hypersensitivity: discontinue if allergic reaction occurs.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Metoclopramide can interact with other medicines, requiring careful management.

Major Interactions (Avoid)

• Antipsychotics (e.g., haloperidol): increased risk of extrapyramidal symptoms.
• CNS depressants (e.g., benzodiazepines): additive sedation and respiratory depression.
• Anticholinergic agents: reduced prokinetic efficacy.

Moderate Interactions (Monitor Closely)

• CYP2D6 inhibitors (e.g., fluoxetine): may raise metoclopramide plasma levels.
• Opioids (e.g., morphine): enhanced nausea or reduced gastrointestinal motility.