Chemotherapy-induced nausea and vomiting
Second line
Controls delayed nausea and vomiting after moderately emetogenic chemotherapy when 5-HT3 antagonists fail. SEOM positions metoclopramide as a supportive option.
Prokinetic, dopamine D2 receptor antagonist
ATC code: A03FA01 (Metoclopramide)
Brand names
Reglan, Maxolon
Blocks central and peripheral D2 receptors and adds 5HT4 stimulation in the upper GI tract – accelerates gastric emptying and suppresses nausea. limited courses to 5 days and the daily dose to 30 mg in 2013 due to neurological adverse effects. boxed warning: tardive dyskinesia develops with use beyond 12 weeks, especially in the elderly and in women.
Second line
Controls delayed nausea and vomiting after moderately emetogenic chemotherapy when 5-HT3 antagonists fail. SEOM positions metoclopramide as a supportive option.
Second line
Second-line option in nausea and vomiting of pregnancy after doxylamine-pyridoxine. Epidemiological data show no increase in major malformations.
Second line
Second-line option for postoperative nausea and vomiting prophylaxis and treatment after ondansetron. The 2014 AEMPS alert caps courses at 5 days and the adult dose at 30 mg/day because of extrapyramidal risk.
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FDA Category B. Large epidemiological data in pregnancy do not show an increase in major malformations. SEGO permits short-course use for nausea and vomiting of pregnancy when doxylamine-pyridoxine fails.
Compatible for short courses. Hale L2. Transfers into milk (RID about 4–5%) without clinical problems observed in infants. The 2014 AEMPS restriction limiting treatment to 5 days due to extrapyramidal effects in adults also applies to breastfeeding mothers.
Metoclopramide is evaluated for the following indications with varying evidence strength: Chemotherapy-induced nausea and vomiting (evidence tier B), Nausea and vomiting of pregnancy (evidence tier B), Postoperative nausea and vomiting (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Metoclopramide (≥ 1 in 100): Somnolence, fatigue, Diarrhoea, Asthenia, Extrapyramidal reactions (more frequent in children and young adults). See the Safety section for uncommon and serious reactions.
FDA category B. FDA Category B. Large epidemiological data in pregnancy do not show an increase in major malformations. SEGO permits short-course use for nausea and vomiting of pregnancy when doxylamine-pyridoxine fails.
Compatible for short courses. Hale L2. Transfers into milk (RID about 4–5%) without clinical problems observed in infants. The 2014 AEMPS restriction limiting treatment to 5 days due to extrapyramidal effects in adults also applies to breastfeeding mothers.
Metoclopramide is contraindicated in: Hypersensitivity to metoclopramide; Gastrointestinal haemorrhage, perforation or mechanical obstruction; Phaeochromocytoma; Parkinson disease; Epilepsy. Full list in the Safety section.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.