STUDENT NAME: Mark Lester C.

De Guzman
SECTION: NU-204

MEDICATION: Metoclopramide Hydrochloride

PURPOSE OF MEDICATION

Expected Pharmacological Action Therapeutic

Therapeutic Use
Use

Stimulates motility of upper GI tract, To prevent or reduce nausea and vomiting

increases lower esophageal sphincter tone,
and blocks dopamine receptors at
chemoreceptor trigger zone.
from emetogenic cancer, chemotheraphy,
postoperative nausea and vomiting, to
facilitate small bowel intubation, aid
radiologic exam, delayed gastric emptying
secondary to diabetic gastroaresis, and
lastly for GERD.

Contraindications/Precautions

- Contraindicated in patients hypertensive to drug and in those with pheochromocytoma or

cathecolamine-releasing paraganliomas, tardive dyskinesia, or seizure disorders.
- Contraindicated in patients whom stimulating GI motility might be dangerous (those with
hemorrhage, obstruction, or perforation.
- Drugs can be irreversible tardive dyskinesia, even after drug is stopped. Risk increases
with duration of therapy and total cumulative dose; there is no treatment. Discontinue
drugs if signs and symptoms occur. except in rare cases, avoid treatment for longer than
12 weeks.
- In addition to tardive dyskinesia, drug may cause extrapyramidal signs and symptoms,
parkinsonian symptoms, and motor restlessness.
- Metoclopramide isn’t recommended for use in children due to the risk of tardive
dyskinesia,and other extrapyramidal signs and symptoms as well as the risk of
methemoglobinemia in neonates.
- galactorrhea, amenorrhea, gynecomastia, and impotence have been reportedwith
prolactin-elevating drugs, including methoclopramide.
 - NMS has occurred rarely and maybe fatal. If signs and symptoms develop (fever, CNS
symptoms, irregular pulse, cardiac arrhythmias, or abnormal BP) discontinue the drug.
- Use cautiously in patients with history of depression, parkinsons disease, or HTN.
- It is not a dialyzable drug.
- Overdosed Signs and Symptoms: Drowsiness, disorientation, extrapyramidal reactions,
seizures, lethargy (infants and children).

Interactions

 Anti-cholinergics and opiod analgeics – may antagonize GI motility effects of

metoclopramide. Use together cautiously.
 Antiparkinsonian drugs (dopamine antagonists)- may decrease therapeutic effects
anti-parkinsonian drugs. Monitor Therapy.
 Antipsychotics- may increase toxic effects of anti-psychotics. Don’t use together.
 CNS depressants- may cause additive CNS effects. Avoid using together.
 Cyclosporine- May Increase cyclosporine absorption. Monitor therapy.
 CYP2D6 Inhibitors (bupropion, fluoxetine, paroxetine, quinidine)- May increase
metoclopramide level. Adjust metoclopramide dosage as needed.
 Digoxin- May diminish digoxin absorption. Monitor Therapy.
 MAO inhibitors- May increase the release of catecholamines in patents with HTN. Use
together cautiously.
 Phenothiazines- may increase risk of extrapyramidal effects. Monitor patient closely.
 Alcohol use- may cause addictive CNS effects. Discourage use together.
 Side Effects & Adverse Effects

CNS: anxiety, drowsiness, dystonic reaction, fatigue, lassitude, restlessness, seizures,

suicidal ideation, akathisia, confusion, depression, dizziness, extrapyramidal symptoms,
fever, hallucinations, headache, insomnia, tardive dyskinesia, and NMS.
CV: bradycardia, supraventricular tachycardia, hypotension, fluid retention, transient
HTN, and HF.
GU: Incontinence, urinary frequency, erectile dysfunction.
Hematologic: agranulocytosis and neutropenia.
Skin: Rash and urticaria.
others: Loss of libido, prolactin secretion, gynecomastia and amenorrhea.
Lab test results: May increase LFT values and aldosterone and prolactin levels; May
decrease neurotrophil and granulocyte counts.

Medication Administration

Available forms:

Injection: 5mg/ml
Oral solution: 5mg/5ml
Tablets: 5mg, 10 mg
Tablets (ODT’s): 5mg, 10 mg

Administration:

PO: Give drug every 30 minutes before each meal and at bed time when used for
gastroparesis and GERD.
PO (ODT):
- Give the drug at least 30 minutes before eating and at bed time.
- Give immediately after opening sealed blister. If tablet breaks or crumbles throw it
away and obtain a new one.
- Place tablet on patients tongue. Tell patient to let it melt approximately 1 minute
and then swallow.
IV:
- drug is compatible with D5, W, NSS for injection, dextrose 5% in half NSS, Ringer
injection and lactated Ringer Injection. NSS is the preferred diluent; drug is most
stable in the solution.
- Give doses of 10mg or less by direct injection over 1-2 minutes. diluete doses larger
than 10 mg in 50 ml of compatible diluent, and infuse over at least 15 minutes.
Monitor BP closely.
- There is no need to protect the drug from light if infusion of mixture is given within
24 hours. if protected from light and refrigerated, it’s stable for 48 hours.
- Incompatibilities: Cephalothin, Chloramphenicol, and Sodium Bicarbonate.
IM:
- Inspect For particulate matter and discoloration. If either is present don’t use.
- Inject into large muscle.
Nursing Interventions

 Monitor Bowel sounds.

 Safety and effectiveness of drug haven’t been established for therapy last longer than
12 weeks.
 Drug may cause tardive dyskinesia, parkinsonian syndrome, and more restlessness.
Monitor Involuntary movements of face, tounge, and extremities, which may indicate
tardive dyskinesia or other extrapyramidal adverse effects.
 Monitor patients fever, CNS symptoms, irregular pulse, cardiac arrhythmias, or
abnormal B, which may indicate NMS.
 Monitor patient for dizziness headache, or nervousness, after metoclopramide is
stopped these may indicate withdrawal.
 Diphenhydramine or benztropine may be used to counteract extrapyramidal adverse
from high doses.

Client Education

 Instruct the patient to take ODT’s every 30 minutes before food and at bed time and not
to repeat dose if inadvertently taken with food.
 Teach patient proper drug administration for prescribed formulation.
 Tell patients to avoid activities that require alertness for 2 hours after doses.
 Urge the patient to report persistent or serious adverse reactions promptly.
 Teach patient signs and symptoms of tardive dyskinesia, other extrapyramidal signs and
symptoms, and NMS. Advise the patient to discontinue drug and to seek immediate
medical attention if such signs and symptoms occur.
 Advise patient not to drink alcohol during therapy.