BSN Tracker

metoclopramide

Brand: Reglan

⚠ BBW Beers Criteria Prototype Drug
Drug Class: prokinetic / antiemetic
Drug Family: antiemetic
Subclass: D2 receptor antagonist / 5-HT4 agonist
Organ Systems: gastrointestinalcns

Mechanism of Action

D2 antagonism in CTZ provides antiemetic effect and reduces LES tone; 5-HT4 agonism and D2 antagonism in GI tract increase gastric emptying and reduce nausea.

dopamine D2 receptor (GI and CTZ)5-HT4 receptor (GI — prokinetic)

Indications

  • gastroparesis (diabetic and post-surgical)
  • GERD (short-term)
  • nausea/vomiting
  • hiccups

Contraindications

  • pheochromocytoma
  • seizure disorders
  • GI obstruction
  • perforation
  • Parkinson's disease
  • tardive dyskinesia history

Adverse Effects

Common

  • drowsiness
  • fatigue
  • extrapyramidal symptoms (EPS)
  • hyperprolactinemia

Serious

  • tardive dyskinesia (irreversible with long-term use — BBW)
  • acute dystonic reactions
  • NMS

Pharmacokinetics (ADME)

Absorption ~80% oral
Distribution moderate
Metabolism hepatic
Excretion renal (20% unchanged)
Half-life 5-6 hours
Onset 0.5-1 hours
Peak 1-2 hours
Duration 6-12 hours
Protein Binding 30%
Vd 3-5 L/kg

Drug Interactions

Drug / Agent Mechanism Severity
MAOIs hypertensive crisis risk major
phenothiazines additive EPS/NMS risk major
digoxin reduces digoxin absorption moderate

Nursing Considerations

  1. Limit to <12 weeks due to tardive dyskinesia risk (BBW)
  2. Extrapyramidal reactions: acute dystonia managed with diphenhydramine 25-50 mg IV/IM
  3. Avoid in Parkinson's disease (dopamine antagonism worsens symptoms)
  4. Drowsiness: advise against driving
  5. Hyperprolactinemia: galactorrhea, menstrual irregularities

Clinical Pearls

  • Tardive dyskinesia: involuntary movements (oral-facial-limb) that may be irreversible — monitor and limit duration
  • Central D2 antagonism crosses BBB: causes CNS side effects (unlike domperidone — peripheral-only)

Safety Profile

Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Gastroparesis (diabetic And Post-surgical) GERD (short-term) Hiccups Nausea/vomiting Prokinetic / Antiemetic
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