Metoclopramide (Perioperative PONV)

How it works

It blocks central dopamine (D2) receptors in the chemoreceptor trigger zone and, peripherally, enhances upper gastrointestinal motility, together reducing nausea and vomiting.

Prescribing in practice

• Because of the risk of extrapyramidal reactions (including acute dystonia, especially in young adults and children) and tardive dyskinesia, restrict to short-term use, use the lowest effective dose, and avoid in Parkinson's disease, phaeochromocytoma and gastrointestinal obstruction or perforation.
• Give intravenous doses slowly to reduce restlessness and akathisia; it is a relatively weak PONV agent and is often combined with other antiemetics of a different class.
• Avoid combining with other dopamine antagonists and use cautiously with drugs that prolong the QT interval.

Monitoring

Monitor for extrapyramidal and dystonic reactions and akathisia, and the resolution of nausea and vomiting after administration.

Counselling the patient

• Explain it is a short-course medicine to prevent or treat sickness after your operation.
• Seek help urgently if you develop muscle spasms, restlessness or abnormal movements of the face or limbs.

Evidence & guidelines

Metoclopramide is an established but second-line PONV agent; MHRA advice and the SPC limit dose and duration owing to neurological adverse effects, and it is typically used within multimodal antiemetic regimens.