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metoclopramide (met oh kloh PRA mide)
What is metoclopramide?
This drug acts on the muscles within the wall of the upper intestinal tract causing them to contract and to move food and fluid along. It also crosses from the blood stream into brain cells and may cause significant side effects (see below).
What is it used for?
The drug is used to treat gastroparesis which means a weak stomach. Some patients, especially diabetics, do not empty food out of their stomach properly. This drug causes the stomach to contract more normally. The second main use is in gastroesophageal reflux disease (GERD). In GERD the valve muscle around the lower esophagus does not contract well and so allows stomach acid and digestive enzymes to reflux up into it. By tightening this muscle, reflux is prevented.
How do I take it?
Follow your physician’s instructions carefully. Take the tablet or syrup 30 minutes before each meal and at bedtime. Tablets may be crushed. Store at room temperature in a tightly sealed container. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and return to your regular schedule. Do not double up on this medication.
Are there interactions with food or beverages?
There are no known interactions with food or beverages. Alcohol should be used with caution or avoided because the combination can result in excessive sedation or marked intoxication.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.
Interactions with this drug may occur with the following:
- cimetidine (Tagamet)
- acetaminophen (Tylenol)
- cyclosporine (Sandimmune, Neoral)
- digoxin (Lanoxin)
- monoamine oxidase (MAO) inhibitors (Nardil, Parnate)
- levodopa (Sinemet)
- narcotic pain medication (Percocet, Demerol)
- sleeping pills (Dalmane, Ambien)
- tetracycline (Achromycin)
- tranquilizers (Valium, Xanax)
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease.
With this drug, the following disorders may be a problem:
- Tardive dyskinesia
- hypertension (high blood pressure)
- partial block of or recent surgery on the bowel
- chronic kidney disease
- epilepsy or seizures
- diabetes – insulin requirement may change
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash, hives and itching. Of course, a person should not take metoclopramide if there has been a previous reaction to this or a similar drug.
What if I’m pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Metoclopramide is ranked B. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
In males, metoclopramide can cause an enlargement or soreness of the breasts, a decrease in sex drive or sperm count, or an impaired or abnormally sustained erection (priapism). Females may experience a change in their menstrual cycle, breast tenderness and swelling, or galactorrhea which is the continual discharge of milk.
Are there other precautions?
Metoclopramide may cause drowsiness so avoid driving or operating hazardous machinery until the drug’s effects have been determined. Irritability and insomnia are other common side effects. Notify your physician if involuntary movements of the eyes, face or limbs occur. This drug is not recommended for patients under 18 years of age.
How long is it safe to take metoclopramide?
Continued use of the drug for 5 to 7 days is necessary to determine metoclopramide’s effectiveness. Long-term use of months to years requires physician supervision.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For metoclopramide, the following are the observed side effects:
- dry mouth
- breast soreness and swelling
- jerky movements of face or head
- muscle spasms
- severe increase in blood pressure
- abnormal heart rate
A physician’s comment…
Metoclopramide is an older drug about which a great deal is known. Although it has many troublesome side effects, many people can take this drug without a problem. Another drug called domperidone has similiar actions but without the long list of side effects. This drug is only available in Canada and Europe at this time.