Treatment Name: Metoclopramide (Reglan®)
Metoclopramide (Reglan®) is a Supportive Care Therapy to prevent or treat Nausea and Vomiting
How does metoclopramide (Reglan®) work?
- Metoclopramide is designed to block dopamine (DA) receptors inside your brain in an area called the “chemoreceptor trigger zone.” These receptors are responsible for the feeling of nausea and the action of vomiting
- When chemotherapy is given, it can cause dopamine to be released and when dopamine binds to DA receptors in the brain, the body can trigger vomiting. Metoclopramide works by binding to DA receptors instead of dopamine, and thereby stops the reflex to vomit
- Metoclopramide (Reglan®) may also work by moving stomach contents along and into your small intestine (often referred to as increased motility or “peristalsis”). Metoclopramide is sometimes prescribed when someone feels full shortly after eating a few bites of food, which can lead to nausea, vomiting or bloating. This is known as “early satiety.” Relief of nausea and vomiting may occur earlier than the relief of abdominal fullness, which can take a week or more to get better
Goals of therapy:
Metoclopramide (Reglan®) can be taken on a scheduled basis to prevent nausea and vomiting before chemotherapy, or can be taken on an as needed basis to treat nausea or vomiting when they occur. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis.
Metoclopramide (Reglan®) is usually taken at home for breakthrough nausea or vomiting. Metoclopramide usually takes 30 – 60 minutes to work after an oral dose, or 1 – 3 minutes after an intravenous dose (if given by your doctor’s office). Metoclopramide may also be given in an outpatient infusion center before chemotherapy to prevent nausea and vomiting
- Usual metoclopramide (Reglan®) starting dose at home:
- Metoclopramide 10 to 20 mg oral tablet by mouth every 4 to 6 hours as needed for nausea and vomiting
- Elderly patients, or those with reduced kidney function may be more sensitive to metoclopramide and only require 5 mg per dose
- Usual metoclopramide (Reglan®) starting dose just before chemotherapy:
- Metoclopramide 10 to 20 mg oral tablet by mouth approximately 30 minutes before chemotherapy 10 to 20 mg intravenous push (I.V. push) approximately 30 minutes before chemotherapy Elderly patients, or those with reduced kidney function may be more sensitive to metoclopramide and only require 5 mg per dose
Metoclopramide (Reglan®) is typically taken on an as needed basis or given scheduled until chemotherapy treatment is complete. Duration of therapy depends upon response, tolerability, and number of cycles chemotherapy prescribed.
Store metoclopramide at room temperature (68°-77°F).
In the prescribing label information (metoclopramide (Reglan®) package insert), the most commonly reported side effects from metoclopramide (Reglan®) are shown here:
- Diarrhea (common)
- Restlessness (10%)
- Drowsiness or sleepiness (10%)
- Fatigue (10%)
- Trouble sleeping when you want to sleep (less than 10%)
- Headache (less than 10%)
- Confusion (less than 10%)
- Dizziness (less than 10%)
- Uncontrollable muscle movement
- Increased or decreased blood pressure
- Low white blood cells
- Increased or decreased heart rate
- Fluid retention
- Milky discharge from breast (galactorrhea, rare)
Metoclopramide should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby. Metoclopramide is excreted in human breast milk, therefore women taking metoclopramide should consult with their doctor before breast-feeding.
Note: The exact percentages of patients that will experience metoclopramide side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials.
How often is monitoring needed?
Labs (blood tests) typically do not need to be monitored for metoclopramide, but may be checked before each chemotherapy treatment. Because the majority of each metoclopramide dose is eliminated in the urine, the serum creatinine (SCr) found in a comprehensive metabolic panel (CMP) may be used to assess how well your kidneys are working.
How often is imaging needed?
Although not required for everyone, your doctor may recommend an electrocardiogram (“ECG” or “EKG”) to check your heart rhythm as metoclopramide (Reglan®) can prolong the QTc interval and increase the risk of a heart arrhythmia.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue metoclopramide (Reglan®) as planned, add additional medications for nausea or vomiting, or switch to an alternative therapy if side effects are experienced and thought to be related to metoclopramide (Reglan®).
If the SCr is elevated, the kidneys may not be able to eliminate metoclopramide as quickly. This may lead to more side effects, such as sedation or sleepiness.
- You may take metoclopramide at the first sign of nausea. Its important not to wait until the nausea gets too severe to take your dose as it takes approximately 30 minutes for the drug to work and if vomiting occurs before then, you may end up vomiting up your dose of metoclopramide
- Metoclopramide speeds up the movement of the intestine and moves liquid and food through the digestive tract faster which may lead to diarrhea
- Unless instructed by your doctor, metoclopramide should not be taken during periods of severe constipation due to the risk of causing the lining of the intestine to break down (known as a perforation), which can lead to bleeding or infection
- Metoclopramide may cause muscle spasms or twitching in certain individuals. These involuntary movements are collectively referred to as “extrapyramidal symptoms", or “EPS.” A sub-type of EPS are called “dystonias.” which are muscle spasms of head or neck muscles, or tongue. Dystonias occur shortly after taking the first dose of metoclopramide or in the first few days of treatment and usually resolve within 24 hours after the last dose of metoclopramide . At dosages of 40 mg per day or less, the risk of involuntary muscle twitching is estimated to affect 1 in 500 people
- If muscle spasms occur, stop taking metoclopramide and consider trying diphenhydramine (Benadryl®) available over-the-counter as a possible antidote. Diphenhydramine may be taken by following the directions on the package until the muscle spasms go away
- You should still contact your doctor if you experience any uncontrollable shaking or muscle movements, as this could be a sign of a serious side effect from metoclopramide
- Unless instructed by your doctor, limit use of metoclopramide to 12 weeks in total duration
- If possible, it is best to limit the amount of metoclopramide and the duration it is taken to decrease the risk of irreversible involuntary movements, known as tardive dyskinesia. The risk of tardive dyskinesia increases with higher metoclopramide doses and therapy longer than 12 weeks, and may not go away once the medication is stopped
- If you experience excessive sleepiness while taking metoclopramide, ask your doctor or pharmacist if lowering the dosage may be appropriate
- Do not take metoclopramide more frequently than prescribed as this increases the risk of experiencing side effects. You may use other anti-nausea medications such as ondansetron (Zofran®) if you are still experiencing nausea after taking metoclopramide
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately. Additive sedating effects can be seen if metoclopramide is combines with alcohol, opioid pain medications, or sedatives such as lorazepam
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Metoclopramide (Reglan®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Metoclopramide (Reglan®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Metoclopramide (Reglan®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.