Metoclopramide – What are the indications and contraindication?

Metoclopramide is an antiemetic and GI stimulant antidopaminergic drug.

MOA:

• Acts as an antagonist at the D2 dopamine receptors when given in higher doses and blocks serotonin receptors in the chemoreceptor trigger zone of the medulla, blocking the activation of the vomiting reflex pathway.
• Enhances the motility of the upper GI tract and increases gastric emptying without affecting gastric, biliary, or pancreatic secretions.
• Increases duodenal peristalsis, decreasing intestinal transit time.
• Increases lower esophageal sphincter tone.

Indications:

• Chemotherapy or radiation induced nausea and vomiting
• Gastroesophageal reflux disease (second-line short-term therapy)
• Gastroparesis

Contraindications:

• Hypersensitivity
• Gastrointestinal obstruction, perforation, or hemorrhage, paralytic ileus
• Seizures
• Epilepsy
• Parkinson’s disease
• Pheochromocytoma
• History or tardive dyskinesia or dystonic reaction to Metoclopramide
• Concomitant use of drugs likely to cause extrapyramidal symptoms

Interactions:

• Increased sedative effects with CNS depressants
• Synergistic toxicity with other dopamine antagonists
• As with all drugs that affect intestinal transit time, Metoclopramide can decrease absorption of drugs taken simultaneously

Adverse Effects:

• Given its effects on dopamine, it has extra-pyramidal side effects (movement disorders, dystonic reactions, pseudoparkinsonism or akathisia due to dopamine antagonism in the substantia nigra) and should be prescribed with caution in patients in Parkinson’s disease
• Can produce serotonin-mediated CNS side effects (anxiety, headache, fatigue, seizures)
• Amenorrhea and galactorrhea due to hyperprolactinemia

From a pharmacognosy perspective, Cannabis sativa and Zingiber officinale are effective at decreasing nausea.

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This post was written by Omar Rifai