Skip to main content

Unfortunately we don't fully support your browser. If you have the option to, please upgrade to a newer version or use Mozilla Firefox, Microsoft Edge, Google Chrome, or Safari 14 or newer. If you are unable to, and need support, please send us your feedback.

Elsevier
Publish with us
AI-Generated response:

What are contraindications to the use of Metoclopramide?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Metoclopramide is contraindicated in patients with gastrointestinal bleeding, obstruction, or perforation, pheochromocytoma, epilepsy, tardive dyskinesia, and hypersensitivity to the drug.

  • Use of metoclopramide can be dangerous in conditions where stimulation of gastrointestinal motility might pose a risk, such as gastrointestinal hemorrhage, mechanical obstruction, or perforation.[1-3]

  • It is contraindicated in patients with pheochromocytoma due to the risk of hypertensive crisis from catecholamine release.[1-3]

  • Patients with epilepsy should avoid metoclopramide as it may increase the frequency and severity of seizures.[1-3]

  • Metoclopramide should not be used in patients with a history of tardive dyskinesia or those who have had a dystonic reaction to the drug.[1-3]

  • Hypersensitivity to metoclopramide, including reactions like laryngeal and glossal angioedema and bronchospasm, is a contraindication.[1-3]

Additional info

Metoclopramide acts as a central dopamine antagonist, which can lead to extrapyramidal symptoms such as tardive dyskinesia, a potentially irreversible condition characterized by involuntary movements. This risk is particularly noted when used with other drugs that increase extrapyramidal effects, such as phenothiazines.[1] Additionally, the drug can cause sedation and dizziness, impairing the ability to perform tasks requiring mental alertness such as driving or operating machinery.[1] It is also structurally similar to procainamide, so caution is advised in patients with procainamide hypersensitivity.[1] These considerations are crucial in clinical decision-making to ensure patient safety and effective management of conditions requiring metoclopramide therapy.

References

Reference 1

1.

Metoclopramide, Elsevier ClinicalKey Drug Monograph Content last updated: February 5, 2024

Contraindications And Precautions 1. GI bleeding 2. GI obstruction 3. GI perforation 4. pheochromocytoma 5. seizure disorder 6. seizures 7. tardive dyskinesia

Contraindications CONTRAINDICATIONS Metoclopramide (metoclopramide hydrochloride) should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g. in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation. Metoclopramide (metoclopramide hydrochloride) is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phentolamine. Metoclopramide (metoclopramide hydrochloride) is contraindicated in patients with known sensitivity or intolerance to the drug. Metoclopramide (metoclopramide hydrochloride) should not be used in epileptics or patients receiving other drugs, which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

Contraindications And Precautions Because metoclopramide produces a transient increase in plasma aldosterone, certain patients, especially those with congestive heart failure, may be at risk of developing fluid retention and volume overload. If these side effects occur at any time during metoclopramide therapy, the drug should be discontinued. Caution is also recommended in patients with existing hypertension or cardiac disease that may be sensitive to catecholamine release. Metoclopramide is contraindicated in patients with pheochromocytoma because it can stimulate the release of catecholamines, possibly leading to a hypertensive crisis.

Contraindications And Precautions Metoclopramide should not be used in those patients with hypersensitivity to the drug or its components. Reactions have included laryngeal and glossal angioedema and bronchospasm. Since metoclopramide is structurally related to procainamide, metoclopramide should be used cautiously in patients with a known procaine or procainamide hypersensitivity due to some structural similarities with these agents. Some oral liquid preparations may contain parabens (hydroxybenzoates) and should be used with caution in patients with a known paraben hypersensitivity.

Interactions Prometh Plain: (Contraindicated) Avoid metoclopramide in patients receiving phenothiazine antipsychotics due to potential for additive effects, including increased frequency and severity of tardive dyskinesia (TD), other extrapyramidal symptoms (EPS), and neuroleptic malignant syndrome (NMS). Also avoid the use of metoclopramide with phenothiazine antiemetics if possible due to these risks. Some manufacturer labels for metoclopramide contraindicate the use of these drugs together, while others state avoidance is necessary. If these agents must be used together, monitor closely for movement disorders and additive CNS effects. Discontinue these medications at the first signs of dyskinesia. Metoclopramide is a central dopamine antagonist and may cause EPS (e.g., acute dystonic reactions, pseudo-parkinsonism, akathisia, tardive dyskinesia). Tardive dyskinesia (TD) is a syndrome of potentially irreversible and disfiguring involuntary movements of the face or tongue, and sometimes of the trunk and/or extremities. Movements may be choreoathetotic in appearance. Phenothiazines are also central dopamine antagonists. In addition, both phenothiazines and metoclopramide can cause sedation, seizures, or increased prolactin levels.

Contraindications And Precautions Various CNS reactions can occur with metoclopramide therapy and may be dose-dependent. Avoid the use of injectable, oral, and nasal metoclopramide chronically in patients with a history of depression; use only when the expected benefits of therapy outweigh the potential risks. Reported symptoms in patients with and without a history of depression have ranged from mild to severe, and include suicidal ideation and suicide. Inform the patient or their caregiver that metoclopramide can cause drowsiness or dizziness, or otherwise impair mental and/or physical abilities. Patients should not perform activities requiring coordination and concentration, such as driving or operating machinery, until they are aware of how metoclopramide affects them. A small number of patients may experience discontinuation symptoms, such as dizziness, nervousness, and/or headaches following abrupt discontinuation of metoclopramide. A slower taper when stopping metoclopramide may be appropriate for some patients, although this is not typically recommended.

Reference 2

2.

Food and Drug Administration (DailyMed). METOCLOPRAMIDE hydrochloride. 2020. Publish date: December 3, 2020

Contraindications 4 CONTRAINDICATIONS Metoclopramide Orally Disintegrating Tablets is contraindicated: In patients with a history of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide [see Warnings and Precautions (5.1, 5.2)]. When stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation). In patients with pheochromocytoma or other catecholamine-releasing paragangliomas. Reglan may cause a hypertensive/pheochromocytoma crisis, probably due to release of catecholamines from the tumor [ see Warnings and Precautions (5.5 )]. In patients with epilepsy. Reglan may increase the frequency and severity of seizures [see Adverse Reactions (6) ]. In patients with hypersensitivity to metoclopramide. Reactions have included laryngeal and glossal angioedema and bronchospasm [see Adverse Reactions (6) ]. History of TD or dystonic reaction to metoclopramide ( 4 ) When stimulation of gastrointestinal motility might be dangerous ( 4 ) Pheochromocytoma, catecholamine-releasing paragangliomas ( 4 ) Epilepsy ( 4 ) Hypersensitivity to metoclopramide ( 4 )

Reference 3

3.

Food and Drug Administration (DailyMed). GIMOTI. 2021. Publish date: January 4, 2021

Contraindications 4 CONTRAINDICATIONS GIMOTI (metoclopramide hydrochloride) is contraindicated: In patients with a history of tardive dyskinesia (TD) or a dystonic reaction to metoclopramide [see Warnings and Precautions (5.1, 5.2) ]. When stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation). In patients with pheochromocytoma or other catecholamine-releasing paragangliomas. Metoclopramide may cause a hypertensive/pheochromocytoma crisis, probably due to release of catecholamines from the tumor [see Warnings and Precautions (5.5) ]. In patients with epilepsy. Metoclopramide may increase the frequency and severity of seizures [see Adverse Reactions (6) ]. In patients with hypersensitivity to metoclopramide. Reactions have included laryngeal and glossal angioedema and bronchospasm [see Adverse Reactions (6) ]. History of TD or dystonic reaction to metoclopramide ( 4 ) When stimulation of gastrointestinal motility might be dangerous ( 4 ) Pheochromocytoma, catecholamine-releasing paragangliomas ( 4 ) Epilepsy ( 4 ) Hypersensitivity to metoclopramide ( 4 )

Follow up questions