Metoclopramide hydrochloride

How it works

It blocks central and peripheral dopamine D2 receptors, suppressing the chemoreceptor trigger zone while enhancing gastric and upper gastrointestinal motility, with additional 5-HT3 antagonism and weak 5-HT4 agonism at higher doses.

Prescribing in practice

• Because of the risk of extrapyramidal and other neurological effects, MHRA advice restricts metoclopramide to short-term use and to standard rather than high doses, with particular caution and dose limitation in children and young adults.
• It is contraindicated in gastrointestinal obstruction, perforation or haemorrhage, in phaeochromocytoma, and shortly after gastrointestinal surgery, and dose reduction is needed in renal or hepatic impairment.
• Acute dystonic reactions can occur early in treatment, and concurrent use with other dopamine antagonists increases the risk of extrapyramidal effects.

Monitoring

Monitor for extrapyramidal symptoms, tardive dyskinesia with prolonged use, and signs of neuroleptic malignant syndrome, reviewing the need for continued treatment regularly.

Counselling the patient

• Use this medicine only for the short course your prescriber advises.
• Stop and seek urgent help if you develop abnormal movements, muscle spasms of the face or neck, or restlessness.

Evidence & guidelines

Following a European review, the MHRA restricted metoclopramide to short-term use at standard doses to reduce the risk of neurological adverse effects.