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Dopamine D2 Antagonist / Prokinetic (Antiemetic) Pregnancy: B — used in hyperemesis gravidarum (first-line with cyclizine); generally considered safe

Metoclopramide (Perioperative PONV)

Brand names: Maxolon, Primperan

Adult dose

Dose: PONV: 10 mg IV/IM/oral. Prokinetic: 10 mg oral/IV TDS (30 min before meals)
Route: IV slow injection, IM, or oral
Frequency: Every 8 hours (TDS); single dose perioperatively
Max: 30 mg/day (5 days maximum)
MHRA 2013: restrict to max 5-day courses; max dose 30 mg/day. IV: give SLOWLY over at least 3 min (rapid IV causes transient intense anxiety and dyskinesia). Less effective than ondansetron for PONV — third-line antiemetic.

Paediatric dose

Dose: 0.1 mg/kg
Route: IV or oral
Frequency: Three times daily
Max: 0.5 mg/kg/day (max 10 mg per dose, max 30 mg/day)
Concentration: 5 mg/mL mg/ml
Children: 0.1 mg/kg/dose TDS. Max 5 mg for children <14 years (BNF). Avoid in neonates — immature blood-brain barrier increases extrapyramidal risk.

Dose adjustments

Renal

Reduce dose by 50% in severe renal impairment

Hepatic

Reduce dose in severe hepatic impairment

Paediatric weight-based calculator

Children: 0.1 mg/kg/dose TDS. Max 5 mg for children <14 years (BNF). Avoid in neonates — immature blood-brain barrier increases extrapyramidal risk.

Clinical pearls

  • Acute dystonia: dystonic reactions occur within minutes of IV dose — typically in young women; treat with procyclidine 5–10 mg IV or biperiden IM
  • MHRA 2013: 5-day maximum course to reduce tardive dyskinesia risk — do NOT use as long-term prokinetic
  • Parenteral route: give IV SLOWLY over 3 min minimum — rapid injection causes transient anxiety and dystonic reactions
  • Third-line PONV: ondansetron and dexamethasone are more effective — use metoclopramide when first-line agents insufficient or contraindicated
  • Prokinetic use: effective for delayed gastric emptying (gastroparesis) — short courses only

Contraindications

  • GI obstruction, perforation, or haemorrhage
  • Phaeochromocytoma
  • Epilepsy
  • Parkinson's disease

Side effects

  • Extrapyramidal reactions (acute dystonia — especially in young women)
  • Tardive dyskinesia (prolonged courses — risk reason for MHRA 5-day limit)
  • Restlessness/akathisia
  • Drowsiness
  • Hyperprolactinaemia
  • QT prolongation (rare)

Interactions

  • Antipsychotics — additive extrapyramidal effects
  • Dopaminergic drugs (levodopa) — antagonism (contraindicated in Parkinson's)
  • Opioids — inhibits prokinetic effect

Monitoring

  • Extrapyramidal signs (dystonia, akathisia)
  • GI symptoms and bowel function
  • Duration of course (max 5 days)

Reference: BNFc; BNF; MHRA Drug Safety Update 2013 (metoclopramide); SAMBA PONV Guidelines 2020. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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