Metoclopramide (Metoclopramide Hydrochloride)
Also sold as: Perinorm, Maxolon, Reglan, Metoclop, Emeset (not same), Peri
Pregnancy
Cat B
Lactation
Caution
Schedule
H
Forms
Tablet 10mg +2
Indications
- Nausea and vomiting (postoperative, drug-induced, radiotherapy-induced)
- Chemotherapy-induced nausea and vomiting (CINV) — less used now due to better alternatives
- Diabetic gastroparesis
- Gastroesophageal reflux disease (short-term adjunct)
- Gastric stasis (small bowel intubation, radiological examination facilitation)
- Migraine-associated nausea
- Hiccups (intractable)
Adult Dosing
Nausea and vomiting
10mg three times daily
Maximum 5 days; MUST NOT exceed 12 weeks total cumulative use
Take 30 minutes before meals and at bedtime
Diabetic gastroparesis
10mg three times daily (30 min before meals) and at bedtime
2–8 weeks; reassess regularly; avoid long-term use
IV/IM (acute nausea or vomiting)
10mg IV/IM every 6–8 hours
Short-term; switch to oral when tolerated
Administer IV over at least 3 minutes (not rapid bolus — risk of dystonia)
Migraine (with nausea)
10mg IV/IM or oral at onset
Single dose; may repeat after 6 hours if needed
Pre-procedure (radiological)
10–20mg IV 5–10 minutes before procedure
Single dose
Pediatric Dosing
Children and adolescents are at significantly higher risk of extrapyramidal reactions (dystonias). Use only when clearly necessary. Contraindicated in infants <1 year (risk of methemoglobinemia and CNS side effects).
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 15–40 mL/min (moderate CKD) | Reduce dose by 50%; 5mg TDS |
| CrCl <15 mL/min (severe CKD / ESRD) | Avoid or use with extreme caution; 5mg OD–BD maximum |
| Hemodialysis | Minimally dialyzable; avoid if possible |
Hepatic Adjustment
Severe hepatic impairment: reduce dose by 50%. Metoclopramide undergoes significant hepatic metabolism.
Pregnancy & Lactation
Pregnancy: Category B
No evidence of teratogenicity in humans. Used for morning sickness when other treatments fail. Avoid near-term or at delivery (neonatal extrapyramidal reactions reported). Preferred only when benefit clearly outweighs risk.
Lactation: Caution
Excreted in breast milk. Historically used as a galactagogue — not recommended for this purpose due to risk of infant neurological effects. Monitor infant for sedation and extrapyramidal symptoms.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Levodopa / Dopaminergic drugs | Metoclopramide (dopamine antagonist) opposes levodopa effects; may worsen Parkinson's symptoms; avoid combination | Major |
| Haloperidol / Phenothiazines / Other dopamine antagonists | Additive extrapyramidal side effects; increased risk of tardive dyskinesia and neuroleptic malignant syndrome | Major |
| MAO inhibitors | Risk of severe hypertensive crisis; avoid concomitant use | Major |
| Digoxin | Increased gut motility may reduce digoxin absorption; monitor digoxin levels | Moderate |
| Cyclosporine | Metoclopramide increases cyclosporine absorption and peak levels; risk of cyclosporine toxicity | Moderate |
| Opioids / Anticholinergics | Reduce metoclopramide's prokinetic effects; antagonistic interaction | Moderate |
| Alcohol / CNS depressants | Additive sedation | Minor |
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Side Effects
Common
- Drowsiness / Sedation
- Restlessness (akathisia)
- Fatigue
- Diarrhea
- Headache
- Dry mouth
Serious / Discontinue If
- TARDIVE DYSKINESIA — involuntary repetitive movements of face, tongue, limbs (may be irreversible; risk increases with dose and duration; BLACK BOX WARNING equivalent — max 12 weeks use)
- Acute dystonic reactions — oculogyric crisis, torticollis, trismus (especially in young patients and children)
- Akathisia — severe motor restlessness, may be mistaken for anxiety
- Parkinsonism (tremor, rigidity, bradykinesia) — especially in elderly
- Neuroleptic malignant syndrome (rare but life-threatening)
- Methemoglobinemia (rare; neonates and infants at risk)
- QT prolongation (rare; especially IV use)
- Hyperprolactinemia → galactorrhea, gynecomastia, menstrual irregularities
Contraindications
- Pheochromocytoma (risk of hypertensive crisis)
- Epilepsy / Seizure disorders (lowers seizure threshold)
- History of tardive dyskinesia or extrapyramidal disorders
- Parkinson's disease or use of dopaminergic drugs
- Gastrointestinal obstruction, perforation, or hemorrhage (prokinetic may worsen)
- Methemoglobinemia or NADH-cytochrome b5 reductase deficiency
- Prolactin-dependent tumors
- Infants <1 year (IV use)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Perinorm | Ipca Laboratories | 10 tab ₹18 |
| Maxolon | Shire Pharmaceuticals (Napp) | 10 tab ₹22 |
| Metoclop | Mankind Pharma | 10 tab ₹15 |
| Peri | Alkem Laboratories | 10 tab ₹16 |
| Emitop | Torrent Pharmaceuticals | 10 tab ₹20 |
Monitoring Required
- Neurological assessment at each visit — any involuntary movements, tremor, rigidity
- Discontinue immediately if signs of tardive dyskinesia or other EPS appear
- Reassess need for continued use every 4–6 weeks
- Methemoglobin levels in at-risk patients (neonates, NADH reductase deficiency)
- Prolactin levels if galactorrhea or gynecomastia occurs
- Renal function in CKD patients
Patient Counseling Points
- IMPORTANT: Do not use for more than 5 days for acute nausea, or more than 12 weeks in total — longer use increases irreversible movement disorder risk
- Take 30 minutes before meals
- Avoid alcohol and other sedatives — additive drowsiness
- Do not drive or operate machinery until you know how this drug affects you
- Report immediately: any unusual movements of face, tongue, jaw, arms, or legs; severe restlessness; muscle stiffness or spasms
- Patients with Parkinson's disease must NOT use this drug
- Elderly patients: extra caution — higher risk of movement disorders
- Children are especially vulnerable to muscle spasms — seek emergency care if neck or jaw stiffness develops
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EasyClinic auto-flags Metoclopramide interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Anita Desai, MD (Medicine), DM (Neurology), KEM Hospital Mumbai
Last reviewed: 2026-03-10
References
- EMA — Metoclopramide Article 31 Review 2013 (revised dosing and duration restrictions)
- CDSCO SmPC — Metoclopramide Injection 2022
- FDA Tardive Dyskinesia Black Box Warning for Metoclopramide
- UpToDate — Metoclopramide: Drug information
- BNF 85 — Metoclopramide