metoclopramide

Adult Dosing .

Dosage forms:  TAB: 5 mg, 10 mg; ODT: 5 mg, 10 mg; SOL: 5 mg per 5 mL; INJ (pre-filled syringe): 10 mg per 2 mL; INJ (vial): 5 mg per mL

GERD

[chronic sx]

Dose: 10-15 mg PO/IM/IV qid; Max: 60 mg/day; 12wk; Info: start 5 mg PO/IM/IV qid in elderly pts; give 5mg PO/IM/IV qid or 10 mg PO/IM/IV tid, max 30 mg/day in CYP2D6 poor metabolizers; give 30min before meals if tid; give 30min before meals and at bedtime if qid

[intermittent sx]

Dose: up to 20 mg PO/IM/IV x1 before sx

diabetic gastroparesis

[10 mg PO/IM/IV qid]

Max: 40 mg/day; 12wk; Info: start 5 mg PO/IM/IV qid in elderly pts; give 5mg PO/IM/IV qid, max 20 mg/day in CYP2D6 poor metabolizers; give 30min before meals and at bedtime if qid

nausea/vomiting prevention, postop

[10 mg IM/IV x1]

Alt: 20 mg IM/IV x1; Info: give dose near end of procedure; may repeat q6-8h prn; not 1st-line agent

small bowel intubation

[10 mg IV x1 dose]

radiologic exam

[10 mg IV x1 dose]

nausea/vomiting prevention, chemo-related

[highly-emetogenic chemo]

Dose: 2 mg/kg/dose IV q2h x3 doses, then 2 mg/kg/dose IV q3h x3 doses; Start: 30min before chemo; Info: may give 1 mg/kg/dose IV q2h x3 doses, then 1 mg/kg/dose IV q3h x3 doses for less emetogenic chemo

[low-emetogenic parenteral chemo (off-label)]

Dose: 10-20 mg PO/IV x1; Start: 30min before chemo; Info: may repeat 10-20 mg PO/IV qd for multi-day chemo; search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

[oral chemo (off-label)]

Dose: 10-20 mg PO x1 on day 1, then 10-20 mg PO q6h prn; Start: 30min before chemo; Info: search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

refractory nausea/vomiting, chemo-related (off-label)

[10-20 mg PO/IV q4-6h]

Info: search 'CINV' for epocrates Chemo-Induced Nausea & Vomiting in Adults decision tool

nausea/vomiting, migraine-assoc. (off-label)

[10-20 mg IV x1]

Alt: 5-10 mg PO/IM/IV q6-8h prn; Max: 45 mg/day

renal dosing

[GERD, chronic sx]

CrCl <60: 5 mg qid or 10 mg tid, max 30 mg/day; ESRD: 5 mg qid or 10 mg bid, max 20 mg/day

HD: 5 mg qid or 10 mg bid, max 20 mg/day; no supplement after dialysis; PD: 5 mg qid or 10 mg bid, max 20 mg/day; no supplement

[diabetic gastroparesis]

CrCl <60: 5 mg qid, max 20 mg/day; ESRD: 5 mg bid, max 10 mg/day

HD: 5 mg bid, max 10 mg/day; no supplement after dialysis; PD: 5 mg bid, max 10 mg/day; no supplement

[all other indications]

CrCl 40-50: decr. usual dose by 25%; CrCl 10-39: decr. usual dose by 50%; CrCl <10: decr. usual dose by 75%

HD: decr. usual dose by 75%; no supplement after dialysis; PD: decr. usual dose by 75%; no supplement

hepatic dosing

[GERD, chronic sx]

Child-Pugh Class B or C: 5 mg qid or 10 mg tid, max 30 mg/day

[diabetic gastroparesis]

Child-Pugh Class B or C: 5 mg qid, max 20 mg/day

[all other indications]

hepatic impairment: no adjustment

Peds Dosing .

Dosage forms:  TAB: 5 mg, 10 mg; ODT: 5 mg, 10 mg; SOL: 5 mg per 5 mL; INJ (pre-filled syringe): 10 mg per 2 mL; INJ (vial): 5 mg per mL

small bowel intubation

[<6 yo]

Dose: 0.1 mg/kg/dose IV x1

[6-14 yo]

Dose: 2.5-5 mg IV x1

[>14 yo]

Dose: 10 mg IV x1

GERD (off-label)

[0.1-0.2 mg/kg/dose PO/IM/IV qid]

Max: 0.8 mg/kg/24h x12wk; Info: give 30min before meals and at bedtime if qid

nausea/vomiting prevention, chemo-related (off-label)

[1-2 mg/kg/dose IV q2-4h]

Info: give 30min before chemo; pretreat w/ diphenhydramine to decr. EPS; not 1st-line agent

nausea/vomiting prevention, postop (off-label)

[0.1-0.2 mg/kg/dose IV x1]

Info: give dose near end of procedure; may repeat q6-8h prn; not 1st-line agent

nausea/vomiting, migraine-assoc. (off-label)

[2 yo and older]

Dose: 0.2 mg/kg/dose IV x1; Max: 10 mg/dose

renal dosing

[adjust dose amount]

CrCl 40-50: decr. usual dose by 25%; CrCl 10-39: decr. usual dose by 50%; CrCl <10: decr. usual dose by 75%

HD: decr. usual dose by 75%; no supplement after dialysis; PD: decr. usual dose by 75%; no supplement

hepatic dosing

[no adjustment]