Emex , Maxeran , Reglan
Classifications: prokinetic agent (gi stimulant); Therapeutic: gi stimulant
Pregnancy Category: B
5 mg, 10 mg tablets; 5 mg/5 mL solution; 5 mg/mL injection
Potent central dopamine receptor antagonist. Increases resting tone of esophageal sphincter, and tone and amplitude of upper
GI contractions. As a result, gastric emptying and intestinal transit are accelerated with little effect, if any, on gastric,
biliary, or pancreatic secretions. Antiemetic action results from drug-induced elevation of CTZ threshold and enhanced gastric
Enhances GI motility and is an effective antinauseant. In diabetic gastroparesis, indicated by relief of anorexia, nausea,
vomiting, persistent fullness after meals.
Management of diabetic gastric stasis (gastroparesis); to prevent nausea and vomiting associated with emetogenic cancer
chemotherapy (e.g., cisplatin, dacarbazine) or surgery; to facilitate intubation of small bowel; symptomatic treatment of
Sensitivity or intolerance to metoclopramide; allergy to sulfiting agents; history of seizure disorders; concurrent use
of drugs that can cause extrapyramidal symptoms; pheochromocytoma; mechanical GI obstruction or perforation; ileus; history
of breast cancer.
CHF, cardiac disease; sulfite hypersensitivity, asthma, hypokalemia, hypertension; depression; hepatic disease, infertility,
methemoglobin reductase deficiency, Parkinson's disease, kidney dysfunction; GI hemorrhage; G6PD deficiency, procainamide
hypersensitivity, seizure disorder, seizures, tardive dyskinesia; history of intermittent porphyria; pregnancy (category
Route & Dosage
Adult: PO 1015 mg q.i.d. a.c. and h.s.
Child: PO 0.40.8 mg/kg/d in 4 divided doses
Adult: PO/IV/IM 10 mg q.i.d. a.c. and h.s. for 28 wk
Geriatric: PO 5 mg a.c and h.s.
Small-Bowel Intubation, Radiologic Examination
Adult: IM/IV 10 mg administered over 12 min
Child: IM/IV <6 y, 0.1 mg/kg over 12 min; 614 y, 2.55 mg over 12 min
Adult: PO 2040 mg q46h, may repeat IM/IV 2 mg/kg 30 min before antineoplastic administration, may repeat q2h for 2 doses, then q3h for 3 doses if needed
Adult: IM/IV 1020 mg near end of surgery
- Give 30 min before meals and at bedtime.
- Note: Verify correct IV concentration and rate of infusion for administration to infants or children with physician.
PREPARE: Direct: Doses of 10 mg or less may be given undiluted. IV Infusion: Doses >10 mg IV should be diluted in at least 50 mL of D5W, NS, D5/.45% NaCl, RL or other compatible solution.
ADMINISTER: Direct: Give over 12 min (or longer in pediatric patients). IV Infusion: Give over not less than 15 min.
INCOMPATIBILITIES Solution/additive: Calcium gluconate, chloramphenicol, cisplatin, dexamethasone, erythromycin, floxacillin, fluorouracil, furosemide, lorazepam, methotrexate, penicillin G potassium, sodium bicarbonate, tetracyclines. Y-site: Allopurinol, amphotericin B cholesteryl complex, amsacrine, cefepime, doxorubicin liposome, furosemide, propofol, TPN.
- Discard open ampules; do not store for future use.
- Store at 15°30° C (59°86° F) in light-resistant bottle. Tablets are stable for 3 y; solutions
and injections, for 5 y.
Adverse Effects (≥1%)CNS: Mild sedation, fatigue, restlessness,
agitation, headache, insomnia
, disorientation, extrapyramidal symptoms
(acute dystonic type), neurologic malignant syndrome
with injection. GI:
dry mouth, altered drug absorption. Skin:
Urticarial or maculopapular rash. Body as a Whole:
Glossal or periorbital edema. Hematologic:
Galactorrhea, gynecomastia, amenorrhea, impotence. CV: Hypertensive crisis
Diagnostic Test Interference
Metoclopramide may interfere with gonadorelin test by increasing serum prolactin levels.
and other cns depressants
add to sedation; anticholinergics
, opiate analgesics
may antagonize effect on GI motility; phenothiazines
may potentiate extrapyramidal symptoms
; may decrease absorption of acetaminophen, aspirin, atovaquone, diazepam, digoxin, lithium, tetracycline;
may antagonize the effects of amantadine, bromocriptine, levodopa, pergolide, ropinirole, pramipexole;
may cause increase in extrapyramidal and dystonic reactions with phenothiazines
, droperidol, haloperidol, loxapine, metyrosine;
may prolong neuromuscular blocking effects of succinylcholine.
Readily from GI tract. Onset:
3060 min PO; 1015 min IM; 13 min IV
12 h. Duration:
13 h. Distribution:
to most body tissues including CNS
; crosses placenta; distributed into breast milk. Metabolism:
Minimally in liver. Elimination:
95% in urine, 5% in feces. Half-Life:
Assessment & Drug Effects
- Report immediately the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Extrapyramidal
symptoms are most likely to occur in children, young adults, and the older adult and with high-dose treatment of vomiting
associated with cancer chemotherapy. Symptoms can take months to regress.
- Be aware that during early treatment period, serum aldosterone may be elevated; after prolonged administration periods, it
returns to pretreatment level.
- Lab tests: Periodic serum electrolytes.
- Monitor for possible hypernatremia and hypokalemia (see Appendix F), especially if patient has HF or cirrhosis.
- Adverse reactions associated with increased serum prolactin concentration (galactorrhea, menstrual disorders, gynecomastia)
usually disappear within a few weeks or months after drug treatment is stopped.
Patient & Family Education
- Avoid driving and other potentially hazardous activities for a few hours after drug administration.
- Avoid alcohol and other CNS depressants.
- Report S&S of acute dystonia, such as trembling hands and facial grimacing (see Appendix F), immediately.