Metoclopramide – Dopamine antagonist for severe nausea and gut motility disorders.
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What is Metoclopramide?
Metoclopramide is a powerful anti-nausea medication that also enhances gut motility, making it particularly valuable for severe nausea and gastroparesis. However, its use requires careful consideration due to the risk of serious neurological side effects with prolonged use.
Book an online consultation if you’re experiencing severe nausea that hasn’t responded to other treatments, have gastroparesis, or need assessment for gut motility disorders. Our GPs can evaluate your symptoms and determine if Metoclopramide is appropriate while ensuring safe usage protocols.
What is Metoclopramide used for?
- Severe nausea and vomiting
- Gastroparesis (delayed gastric emptying)
- Post-operative nausea and vomiting
- Chemotherapy-induced nausea
- Migraine-associated nausea
- Gastroesophageal reflux disease
- Functional dyspepsia
- Facilitating gastric emptying for procedures
How does Metoclopramide work?
A dopamine D2 receptor antagonist that blocks dopamine in the chemoreceptor trigger zone (reducing nausea) and enhances gut motility by increasing gastric contractions and accelerating gastric emptying.
Dosage and Administration
Adults
10mg up to 3 times daily. Maximum 30mg daily. For gastroparesis: 10mg before meals and at bedtime.
Children
0.1-0.15 mg per kg up to 3 times daily—specialist supervision usually required.
Important Notes
- Take 30 minutes before meals for gastroparesis.
- Can be given by injection in hospital settings for severe cases.
- Short-term use recommended—maximum 5 days without specialist review.
- Take at regular intervals for best effect.
Side Effects
Common Side Effects
- Drowsiness and fatigue
- Restlessness
- Dizziness
- Diarrhoea
- Depression and mood changes
- Breast tenderness (due to prolactin increase)
Serious Side Effects
Seek immediate medical attention if you experience:
- Tardive dyskinesia (irreversible movement disorder)
- Acute dystonia (muscle spasms)
- Neuroleptic malignant syndrome (rare)
- Severe depression or suicidal thoughts
- Parkinsonism
- Galactorrhoea (inappropriate milk production)
Important Warnings
- CRITICAL: Risk of tardive dyskinesia increases with duration of use—limit to short courses.
- Not suitable for people with Parkinson's disease or movement disorders.
- Tell your GP if you develop involuntary movements, muscle spasms, or mood changes.
- Avoid in bowel obstruction, perforation, or bleeding.
- Use with extreme caution in elderly patients—higher risk of movement disorders.
Drug Interactions
Tell your GP if you're taking any of the following medications:
- Antipsychotic medications—increased risk of movement disorders.
- Paracetamol and aspirin—may increase absorption and effects.
- Digoxin—may reduce digoxin absorption.
- Levodopa—antagonizes effects in Parkinson's disease.
- CNS depressants—increased sedation.
- MAOIs—may increase blood pressure effects.
Frequently Asked Questions
Why is Metoclopramide only recommended for short-term use?
Long-term use significantly increases the risk of tardive dyskinesia, a potentially irreversible movement disorder affecting the face and limbs.
How is Metoclopramide different from other anti-nausea medications?
Unlike antihistamines, Metoclopramide also speeds up gastric emptying, making it particularly useful for gastroparesis and situations where delayed stomach emptying contributes to nausea.
Can Metoclopramide be used during pregnancy?
It can be used in pregnancy when benefits outweigh risks, but should be avoided in the first trimester and used with caution under medical supervision.
What should I do if I develop muscle spasms or involuntary movements?
Stop taking Metoclopramide immediately and contact your GP or emergency services, as these may be signs of serious neurological side effects.
Medically Reviewed by: Mohammed Hassan - Independent Prescriber
Last Updated: 2025-01-14