Medicine & USMLE

Metoclopramide

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GI Drugs
  1. Ondansetron
  2. Metoclopramide
  3. Antacids
  4. Proton Pump Inhibitors (PPIs)
  5. H2 Blockers
  6. Bismuth Subsalicylate
  7. Sucralfate
  8. Misoprostol
  9. Docusate (Stool Softener)
  10. Bulk Forming Laxatives (Psyllium, Methylcellulose)
  11. Osmotic Laxatives (Lactulose, PEG)
  12. Stimulant Laxatives (Senna, Bisacodyl)
  13. Antidiarrheals (Loperamide, Diphenoxylate-Atropine)
  14. Orlistat
  15. Octreotide

Summary

Metoclopramide is a medication used to treat nausea and vomiting, gastroparesis, and gastroesophageal reflux or GERD. Side effects of metoclopramide include extrapyramidal symptoms or EPS, which classically include tardive dyskinesia, a syndrome characterized by uncontrollable lip smacking and tongue rolling.

Key Points

  • Metoclopramide (Reglan)
    • Mechanism
      • Dopamine antagonist
        • Block dopamine receptors in the chemoreceptor trigger zone (CTZ)
      • Direct-acting anticholinergic
    • Clinical Use
      • Nausea/Vomiting
        • Chemotherapy
        • Postoperative Recovery
      • Gastroparesis
        • Also called delayed gastric emptying
        • Metoclopramide increases gastric motility
      • Gastroesophageal Reflux Disease (GERD)
    • Side Effects and Adverse Reactions
      • Extrapyramidal Symptoms (EPS)
        • Tardive Dyskinesia
        • Pseudoparkinsonism
        • Akathisia
        • Dystonia
      • Sedation
        • Avoid alcohol and other CNS depressants
      • Anticholinergic Effects
        • Dry mouth, urinary retention, constipation, etc.
        • Expected side effects
      • Hypotension
        • Instruct patient to rise slowly to prevent dizziness and falls
      • Headache