INDICATIONS AND CLINICAL USES:
An adjunct in the management of delayed gastric emptying associated with subacute and chronic gastritis or following vagotomy and pyloroplasty and other surgical procedures.
Metoclopramide has also been found useful as an adjunct to facilitate small bowel intubation.
Metoclopramide has been found useful as an adjunct to facilitate gastroduodenal evacuation of barium meals and improve radiological visualization of the gastroduodenal region in patients with gastric atonia, pylorospasm, spasm of the duodenal bulb, or with mechanical gastric outlet obstruction. Metoclopramide has also been shown to accelerate small bowel transit of the barium meal and to facilitate fluoroscopy of the terminal ileum.
Metoclopramide, when used preoperatively by the oral route, may be useful to reduce postoperative vomiting induced by narcotics.
Should not be used whenever stimulation of gastrointestinal motility might be dangerous; i.e., in the presence of gastrointestinal hemorrhage, mechanical obstruction or perforation.
Metoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug.
Drowsiness, fatigue and lassitude occur in approximately 10% of patients at the usual recommended dosage. Less frequent adverse reactions, occurring in approximately 5% of patients are insomnia, headache, dizziness and bowel disturbances. Galactorrhea and menstrual disorders have also been reported.
The more serious adverse reactions associated with the use of metoclopramide are parkinsonism and/or other extrapyramidal reactions. These consist often of a feeling of restlessness, facial spasms, involuntary movements and in some cases, torticollis, muscular twitching, trismus, oculogyric crisis, and opisthotonos. Dystonic reactions resembling tetanus have been reported. Extrapyramidal side effects appear to occur more frequently at dosages higher than the usual recommended dosage. Tardive dyskinesia, which in some cases appears to be irreversible, has been reported after discontinuation of long-term metoclopramide therapy. Therefore, prolonged treatment with metoclopramide should be avoided.
DOSAGE AND ADMINISTRATION:
Note: The total adult and pediatric daily dosage must not exceed 0.5 mg/kg/body weight.
Delayed Gastric Emptying: Adults: 5 to 10 mg (1-2 spoonfuls or one BARKABROMIDE 10 mg suppository) 3 or 4 times a day before meals, depending upon response and body weight.
Children (5 to 14 years): 2.5 to 5 mg (2.5 to 5 mL drops) 3 times a day before meals, depending on response and body weight.
Diagnostic Radiology: Adults: 20 mg (4 spoonfuls or one BARKABROMIDE 20 mg suppository) 5 to 10 minutes before barium swallow.
Renal or Hepatic Impairment: Since metoclopramide is excreted principally through the kidneys, in those patients whose creatinine clearance is below 40 mL/min, therapy should be initiated at approximately one-half the recommended dosage. Depending upon clinical efficacy and safety considerations, the dosage may be increased or decreased as appropriate.
Metoclopramide undergoes minimal hepatic metabolism, except for simple conjugation. Its safe use has been described in patients with advanced liver disease whose renal function was normal.
Boxes of 10 suppositories.