Metoclopramide - instructions for use, dose, side effects, contraindications

It blocks dopamine D₂-receptors, serotonin receptors, increases the threshold of chemoreceptors in the trigger zone of the vomiting center. Increases the amplitude of contractions of the antral part of the stomach, accelerates the emptying of the stomach. By increasing the pressure in the gallbladder and bile ducts normalizes the separation of bile. Increases the pressure of the sphincter of the esophagus at rest, preventing gastroesophageal reflux.

It causes a transient increase in the concentration of circulating aldosterone and stimulates prolactin production, which is accompanied by a short-term fluid retention.

Pharmacokinetics:

After oral administration, up to 50-70% is absorbed in the gastrointestinal tract. The maximum concentration in blood plasma is achieved after 1-2 hours. The connection with plasma proteins is 15-30%.

The therapeutic effect develops 30-60 minutes after ingestion. With intravenous administration begins to act after 1-3 min. The duration of action is 1-2 hours. It penetrates through blood-brain and placental barriers. Metabolism in the liver.

The half-life is 4-6 hours. Elimination by the kidneys.

Indications:

It is used for hiccups, nausea, vomiting, dyskinesia biliary tract, reflux esophagitis, flatulence. Used in complex therapy for exacerbations of peptic ulcer of the stomach and duodenum, as well as to accelerate peristalsis in radiopaque studies of the gastrointestinal tract.

ICD-10

XI.K20-K31.K21.0 Gastroesophageal reflux with esophagitis

XI.K20-K31.K26 Duodenal ulcer

XI.K20-K31.K25 Stomach ulcer

XI.K80-K87.K82.8 Other specified diseases of the gallbladder

XVIII.R00-R09.R06.6 Hiccups

XVIII.R10-R19.R11 Nausea and vomiting

XVIII.R10-R19.R14 Meteorism and related conditions

XXI.Z40-Z54.Z51.4 Preparatory procedures for subsequent treatment, not elsewhere classified

Contraindications:

Gastrointestinal bleeding, perforation of the stomach or intestines, mechanical intestinal obstruction, glaucoma, epilepsy, prolactin-dependent tumors, individual intolerance.

Carefully:

Bronchial asthma, hepatic and renal insufficiency, arterial hypertension, lactation period, elderly age.

Pregnancy and lactation:

Recommendations for FDA - Category B. It is used according to the indications.

Dosing and Administration:

Application in children

6-18 years of 5 mg 1-3 times / day, by mouth, intravenously and intramuscularly. Daily dose: 1 mg / kg.

Adults

Inside for 5-10 mg 3-4 times / day, washing down with water. Tablets are swallowed whole.

Intravenous and intramuscular: 10-20 mg 1-3 times / day.

The highest daily dose: 60 mg.

The highest single dose: 20 mg.

Side effects:

Central and peripheral nervous system: drowsiness, dizziness, depression; hyperkinesis, spasmodic torticollis, the phenomenon of parkinsonism.

The system of hematopoiesis: agranulocytosis.

Digestive system: diarrhea, constipation, rarely dry mouth.

Reproductive system: disorders of the menstrual cycle, gynecomastia, galactorrhea.

Allergic reactions.

Overdose:

Symtomas: increased side effects.

Treatment: cancellation of the drug.

Interaction:

Strengthens the action of paracetamol, acetylsalicylic acid, levodopa, ethanol, lithium, ampicillin, tetracycline due to acceleration of absorption due to accelerated evacuation from the stomach.

Slows the absorption of digoxin, cimetidine.

Simultaneous use with monoamine oxidase inhibitors can provoke the development of hypertensive crisis.

Reduces the effects of bromocriptine by increasing the concentration of prolactin in the blood plasma.

Enhances extrapyramidal side effects with the use of neuroleptics.

Reduces the effectiveness of levodopa.

Strengthens the effect of drugs that have a depressant effect on the central nervous system, including ethanol.

Special instructions:

Patients who are hypersensitive to procainamide and procaine tend to have an increased sensitivity to metoclopramide.

The total duration of treatment with metoclopramide should not exceed 12 weeks, due to the increased risk of developing tardive dyskinesia.

Instructions

Metoclopramide (Metoclopramidum)