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Antiemetic Pregnancy: A — widely used and considered safe in pregnancy

Metoclopramide

Brand names: Maxolon, Primperan

Adult dose

Dose: 10mg
Route: Oral / IV / IM
Frequency: Three times daily
Max: 30mg/day (5 days maximum)
IV: give over at least 3 min to reduce risk of acute dystonic reaction. Max course 5 days (EMA restriction — tardive dyskinesia risk). Prescribe as PRN rather than regular where possible.

Paediatric dose

Dose: 0.1 mg/kg
Route: Oral / IV
Frequency: Three times daily
Max: 500 mcg/kg per dose (max 10 mg)
Concentration: 5 mg/ml
BNF for Children: 0.1 mg/kg (max 10 mg) per dose TDS — MHRA 2013 restriction caps per-dose maximum at 0.1 mg/kg. Avoid in children <1 year. Max 0.5 mg/kg/day. Short courses only (max 5 days). High risk of extrapyramidal reactions in young patients. Source: BNF for Children 2024; MHRA Metoclopramide Review 2013

Dose adjustments

Renal

Reduce dose by 50% in severe renal impairment.

Paediatric weight-based calculator

BNF for Children: 0.1 mg/kg (max 10 mg) per dose TDS — MHRA 2013 restriction caps per-dose maximum at 0.1 mg/kg. Avoid in children <1 year. Max 0.5 mg/kg/day. Short courses only (max 5 days). High risk of extrapyramidal reactions in young patients. Source: BNF for Children 2024; MHRA Metoclopramide Review 2013

Clinical pearls

  • EMA restriction 2014: max 5 days use due to risk of tardive dyskinesia with longer courses.
  • Acute dystonic reaction: treat with procyclidine 5mg IV or IM (or biperiden 5mg IV). Resolves within 20 min. More common in young women and patients on neuroleptics.
  • Preferred for chemotherapy-induced nausea at low doses. Ondansetron is preferred for PONV and high-emetogenic chemotherapy.
  • Avoid in Parkinson's disease — use domperidone (peripheral dopamine antagonist, does not cross BBB).

Contraindications

  • GI obstruction, perforation, or haemorrhage
  • Phaeochromocytoma (risk of hypertensive crisis)
  • Epilepsy (lowers seizure threshold)
  • Parkinson's disease (dopamine antagonism worsens symptoms)
  • Children <1 year and young adults <20 years (extrapyramidal reaction risk is higher)

Side effects

  • Extrapyramidal reactions — acute dystonia (oculogyric crisis, torticollis): more common in young adults. Treat with procyclidine 5mg IV
  • Tardive dyskinesia (with prolonged use — irreversible)
  • Drowsiness
  • Hyperprolactinaemia (galactorrhoea, amenorrhoea)
  • QT prolongation at high doses

Interactions

  • Opioids: additive gastric emptying effect
  • Dopaminergic drugs (levodopa): antagonism — avoid
  • Alcohol: enhanced sedation
  • QT-prolonging drugs: additive risk

Monitoring

  • Symptoms of dystonia
  • signs of tardive dyskinesia in long-term use

Reference: BNFc; NICE BNF 84; EMA Metoclopramide Review 2014. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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