Antiemetic / Prokinetic
Pregnancy: Caution — avoid in 1st trimester; short-term use in 2nd/3rd trimester if benefit outweighs risk
Metoclopramide
Brand names: Maxolon
Adult dose
Dose: 10 mg
Route: Oral / IM / IV
Frequency: Up to three times daily
Max: 30 mg/day (0.5 mg/kg/day)
Short-term use only (up to 5 days). IV injection: give over at least 3 minutes. Do not exceed 5 days. MHRA 2013 restriction: limit course to 5 days max due to neurological risk.
Paediatric dose
Dose: 0.1 mg/kg
Route: Oral / IV / IM
Frequency: Up to three times daily
Max: 0.5 mg/kg/day
Only for nausea/vomiting associated with chemotherapy, radiotherapy, post-surgery, or delayed gastric emptying. Not for routine use in children — restricted after MHRA 2013 review.
Dose adjustments
Renal
Reduce dose by 50% if eGFR <40 mL/min.
Hepatic
Use with caution in severe hepatic impairment — reduce dose.
Paediatric weight-based calculator
Only for nausea/vomiting associated with chemotherapy, radiotherapy, post-surgery, or delayed gastric emptying. Not for routine use in children — restricted after MHRA 2013 review.
Clinical pearls
- Antidote for acute dystonic reaction: procyclidine 5 mg IV or IM (or benztropine); dramatic response expected within minutes
- MHRA 2013: max 5 days use; avoid in young adults and elderly where possible; max dose 0.5 mg/kg/day
- Prefer ondansetron in young patients due to lower extrapyramidal risk
Contraindications
- Phaeochromocytoma
- GI haemorrhage/perforation/obstruction
- Epilepsy
- History of tardive dyskinesia or neuroleptic malignant syndrome
- Parkinson's disease
Side effects
- Extrapyramidal reactions (dystonia, akathisia — especially in young adults)
- Tardive dyskinesia (prolonged use)
- Hyperprolactinaemia
- Drowsiness
- QT prolongation
- Rarely: neuroleptic malignant syndrome
Interactions
- Antipsychotics (additive extrapyramidal effects)
- Opioids (antagonise prokinetic effect)
- Levodopa (antagonism — avoid in Parkinson's)
- Digoxin (reduces absorption)
- Ciclosporin (increased levels)
Monitoring
- Signs of extrapyramidal reactions
- Duration of use (never exceed 5 days)
Reference: BNFc; BNF 90; MHRA Drug Safety Update 2013 (Metoclopramide). Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators