Detailed Drug Information:

DRUG CLASS: Metoclopramide is a "prokinetic" agentthat increases muscle tone of the lower esophagus sphincter. The loweresophagus sphincter, located between the esophagus and stomach, normallyprevents reflux of acid and other stomach contents into the esophagus. Inpatients with GastroesophagealReflux (GERD), a weakened lower esophagus sphincter allowsreflux of stomach acid into the esophagus, causing heart burn and aciddamage to the esophagus (peptic esophagitis). Metoclopramide decreasesstomach acid reflux by strengthening the lower esophagus sphincter. Likecisapride (Propulsid),metoclopramide also hastens the stomach emptying of solid and liquid mealsinto the intestines. Rapid emptying of meals also help decrease the refluxof stomach acid and other contents into the esophagus.

Metoclopramide interferes with dopamine receptors in the brain. Sincedopamine causes nausea. Metoclopramide can be an effective anti-nauseamedication.

While cisapride and metoclopramide are similar in decreasinggastroesophageal reflux, metoclopramide is more likely to cause nervoussystem side effects such as jitteriness, insomnia, sedation, or anxiety.

PREPARATIONS: tablets: 5 mg and 10mg. Syrup: 5 mg/5 ml

STORAGE: Tablets and syrup should be stored at temperature between 15-30C
(59-86F).

PRESCRIBED FOR: Metoclopramide is used on a short term basis (4to 12 weeks) for patients with heartburn and esophagitis due togastroesophageal reflux. Please also read the GastroesophagealReflux (GERD) article. Stomach nerve damage due to diabetes(diabetic gastric stasis) can cause delayed stomach emptying, resulting innausea, vomiting, fullness, and heartburn. Metoclopramide can be effectivein relieving nausea and other symptoms related to diabetic gastric stasis.Metoclopramide is also used in the treatment of nausea related topostoperative state and cancer chemotherapy.

DOSING: Metoclopramide is usually given four times daily, 30minutes before each meal and at bedtime for the treatment of esophagealreflux. Dosage and frequency may be lowered in elderly patients, and insituations where symptoms occur only intermittently and at specific times.Concurrent administration of Anticholinergic medications can decrease theeffectiveness of metoclopramide.

DRUG INTERACTIONS: Metoclopramide can have nervous system sideeffects, such as depression, anxiety, sedation, restlessness, andinsomnia. Parkinson patients can experience worsening of symptoms withmetoclopramide. Metoclopramide may impair the mental and/or physicalabilities to drive or operate machinery. Rarely, metoclopramide can causeinvoluntary muscle movements, facial grimacing, and dystonic reactionsresembling tetanus. Since metoclopramide accelerates stomach emptying, itcan increase absorption and effects of other medications. For example, theeffects of sedatives such as alcohol and diazepam (Valium) can beaccelerated when used together with metoclopramide. Safety in pregnancy,nursing mothers, and children has not been established.

SIDE EFFECTS: Metoclopramide is generally well tolerated whenused in low doses for brief periods. The nervous system side effectsincrease with higher doses and longer periods of treatment. The commonside effects are mentioned above under Drug Interactions.