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Dopamine D2 Antagonist / Prokinetic (Antiemetic) Pregnancy: A large amount of data on pregnant women (more than 1,000 pregnancy outcomes) indicate no malformative nor feto-toxicity of metoclopramide. Metoclopramide can be used during pregnancy if clinically needed. Due to pharmacological properties (as with other neuroleptics), if metoclopramide is given at the end of pregnancy, extrapyramidal syndrome in the newborn cannot be excluded. Metoclopramide should be avoided at the end of pregnancy; if it is used, neonatal monitoring should be undertaken. Breastfeeding: metoclopramide is excreted in human milk at low levels and adverse reactions in the breastfed baby cannot be excluded; it is not recommended during breastfeeding and discontinuation in breastfeeding women should be considered.

Metoclopramide (Perioperative PONV)

Brand names: Maxolon, Primperan

Metoclopramide is a dopamine-antagonist antiemetic and prokinetic used perioperatively for the prevention and treatment of post-operative nausea and vomiting (PONV).

Adult dose

Dose: Prevention of post-operative nausea and vomiting (PONV) in adults: a single dose of 10 mg
Route: Intravenous (slow bolus over at least 3 minutes) or intramuscular
Frequency: Single dose; a minimal interval of 6 hours between two administrations must be respected
The pinned product, Metoclopramide 5 mg/ml Solution for Injection (eMC product 11550), is licensed in section 4.1 for adults for 'Prevention of post operative nausea and vomiting (PONV)', so the indication matches. ROUTE THIS CARD DOES NOT COVER: oral - this is an injection SPC ('The solution can be administered intravenously or intramuscularly'), so no oral dose is given. Administration: 'Intravenous doses should be administered as a slow bolus (over at least 3 minutes).' Safety condition from section 4.2: 'Due to the risk of severe cardiovascular reactions such as cardiac arrest, the use of the solution for injection is limited to situations where the necessary resuscitation equipment is available.' The injectable treatment duration should be as short as possible, with a switch to oral or rectal treatment as soon as possible. DAILY CEILING NOT CARDED: the SPC prints 'The maximum recommended daily dose is 30 mg or 0.5 mg/kg body weight' only in the paragraph for symptomatic treatment of nausea and vomiting and for prevention of radiotherapy-induced nausea and vomiting (single dose 10 mg repeated up to three times daily); for PONV prevention the SPC gives a single 10 mg dose, so no maxDose is stated for this indication. Elderly: 'a dose reduction should be considered, based on renal and hepatic function and overall weakness.' Cardiac: serious cardiovascular reactions (circulatory collapse, severe bradycardia, cardiac arrest, QT prolongation) have been reported after injection, particularly intravenously; special care in the elderly, in cardiac conduction disorders (including QT prolongation), uncorrected electrolyte imbalance, bradycardia, and with other QT-prolonging drugs. Paediatric: not carded on this adult page. The SPC lists a separate, different paediatric indication (second-line treatment of ESTABLISHED PONV in children aged 1-18 years, with a weight-banded table and a 48-hour limit) and states it is contraindicated in children under 1 year; use a children's formulary.

Dose adjustments

Renal

SPC 4.2: in end stage renal disease (creatinine clearance 15 mL/min or less) the daily dose should be reduced by 75%; in moderate to severe renal impairment (creatinine clearance 15-60 mL/min) the dose should be reduced by 50%. SPC 4.4: in patients with renal impairment a dose reduction is recommended.

Hepatic

SPC 4.2: in patients with severe hepatic impairment the dose should be reduced by 50%. SPC 4.4: in patients with severe hepatic impairment a dose reduction is recommended.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or any of the excipients
  • Gastrointestinal haemorrhage, mechanical obstruction or gastrointestinal perforation for which the stimulation of gastrointestinal motility constitutes a risk
  • Confirmed or suspected phaeochromocytoma (risk of severe hypertension episodes)
  • History of neuroleptic or metoclopramide-induced tardive dyskinesia
  • Epilepsy (increased crisis frequency and intensity)
  • Parkinson's disease
  • Combination with levodopa or dopaminergic agonists
  • Known history of methaemoglobinaemia with metoclopramide or NADH cytochrome b5 deficiency
  • Children less than 1 year of age (increased risk of extrapyramidal disorders)

Side effects

  • Very common: sleepiness
  • Common: extrapyramidal disorders (particularly in children and young adults and/or when the recommended dose is exceeded, even after a single dose), parkinsonism, akathisia; depression; diarrhoea; asthenia; hypotension, particularly with intravenous formulations
  • Uncommon: hypersensitivity; bradycardia, particularly with intravenous formulations; amenorrhoea, hyperprolactinaemia; dystonia (including oculogyric crisis), dyskinesia, depressed level of consciousness; hallucination
  • Rare: galactorrhoea; convulsion especially in epileptic patients; confusional state
  • Not known: anaphylactic reaction (including anaphylactic shock, particularly with intravenous formulations); methaemoglobinaemia, sulfhaemoglobinaemia; cardiac arrest shortly after injectable use (can follow bradycardia), atrioventricular block, sinus arrest, QT prolongation, Torsade de Pointes; tardive dyskinesia, neuroleptic malignant syndrome; suicidal ideation; shock and syncope after injectable use; acute hypertension in patients with phaeochromocytoma; transient increase in blood pressure; gynaecomastia

Interactions

  • Levodopa or dopaminergic agonists: contraindicated combination (mutual antagonism)
  • Alcohol potentiates the sedative effect of metoclopramide (combination to be avoided)
  • Anticholinergics and morphine derivatives: mutual antagonism with metoclopramide on digestive tract motility
  • Central nervous system depressants (morphine derivatives, anxiolytics, sedative H1 antihistamines, sedative antidepressants, barbiturates, clonidine and related products): sedative effects potentiated
  • Neuroleptics: additive effect on the occurrence of extrapyramidal disorders
  • Serotonergic drugs such as SSRIs: increased risk of serotonin syndrome
  • Digoxin: metoclopramide may decrease digoxin bioavailability; monitor digoxin plasma concentration
  • Ciclosporin: bioavailability increased (Cmax by 46% and exposure by 22%); monitor ciclosporin plasma concentration
  • Mivacurium and suxamethonium: metoclopramide may prolong the duration of neuromuscular block (inhibition of plasma cholinesterase)
  • Strong CYP2D6 inhibitors such as fluoxetine and paroxetine increase metoclopramide exposure; monitor for adverse reactions
  • Other QT-prolonging drugs (class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics): special care with injection

Monitoring

  • Ensure resuscitation equipment is available before giving the injection (risk of severe cardiovascular reactions such as cardiac arrest)
  • Give intravenous doses as a slow bolus over at least 3 minutes to reduce the risk of hypotension and akathisia
  • Stop immediately if extrapyramidal symptoms, neuroleptic malignant syndrome symptoms or signs of tardive dyskinesia appear; stop permanently if methaemoglobinaemia occurs
  • Monitor for sedation and hypotension; special care in the elderly, in cardiac conduction disorders (including QT prolongation), uncorrected electrolyte imbalance and bradycardia
  • Respect a minimal interval of 6 hours between two administrations, even in case of vomiting of the dose, to avoid overdose
  • Monitor digoxin and ciclosporin plasma concentrations if used together; monitor for adverse reactions with strong CYP2D6 inhibitors
  • If used at the end of pregnancy, neonatal monitoring should be undertaken

Clinical monograph

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.

Reference: MHRA Drug Safety Update 2013 (metoclopramide); SAMBA PONV Guidelines 2020; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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