Treatment Name: Metoclopramide (Reglan®)

Metoclopramide (Reglan®) is a Supportive Care Therapy to prevent or treat Nausea and Vomiting

How does metoclopramide (Reglan®) work?

Metoclopramide is designed to block dopamine (DA) receptors inside your brain in an area called the “chemoreceptor trigger zone.” These receptors are responsible for the feeling of nausea and the action of vomiting
When chemotherapy is given, it can cause dopamine to be released and when dopamine binds to DA receptors in the brain, the body can trigger vomiting. Metoclopramide works by binding to DA receptors instead of dopamine, and thereby stops the reflex to vomit
Metoclopramide (Reglan®) may also work by moving stomach contents along and into your small intestine (often referred to as increased motility or “peristalsis”). Metoclopramide is sometimes prescribed when someone feels full shortly after eating a few bites of food, which can lead to nausea, vomiting or bloating. This is known as “early satiety.” Relief of nausea and vomiting may occur earlier than the relief of abdominal fullness, which can take a week or more to get better

Goals of therapy:
Metoclopramide (Reglan®) can be taken on a scheduled basis to prevent nausea and vomiting before chemotherapy, or can be taken on an as needed basis to treat nausea or vomiting when they occur. When a medicine is given to prevent nausea and vomiting, it is known as prophylaxis.

Schedule

Metoclopramide (Reglan®) is usually taken at home for breakthrough nausea or vomiting. Metoclopramide usually takes 30 – 60 minutes to work after an oral dose, or 1 – 3 minutes after an intravenous dose (if given by your doctor’s office). Metoclopramide may also be given in an outpatient infusion center before chemotherapy to prevent nausea and vomiting

Usual metoclopramide (Reglan®) starting dose at home:
- Metoclopramide 10 to 20 mg oral tablet by mouth every 4 to 6 hours as needed for nausea and vomiting
- Elderly patients, or those with reduced kidney function may be more sensitive to metoclopramide and only require 5 mg per dose

Usual metoclopramide (Reglan®) starting dose just before chemotherapy:
- Metoclopramide 10 to 20 mg oral tablet by mouth approximately 30 minutes before chemotherapy 10 to 20 mg intravenous push (I.V. push) approximately 30 minutes before chemotherapy Elderly patients, or those with reduced kidney function may be more sensitive to metoclopramide and only require 5 mg per dose

Metoclopramide (Reglan®) is typically taken on an as needed basis or given scheduled until chemotherapy treatment is complete. Duration of therapy depends upon response, tolerability, and number of cycles chemotherapy prescribed.

Store metoclopramide at room temperature (68°-77°F).

Side Effects

In the prescribing label information (metoclopramide (Reglan®) package insert), the most commonly reported side effects from metoclopramide (Reglan®) are shown here:

Metoclopramide should be used in pregnant women only if the potential benefits to the mother outweigh the potential risks to the unborn baby. Metoclopramide is excreted in human breast milk, therefore women taking metoclopramide should consult with their doctor before breast-feeding.

Note: The exact percentages of patients that will experience metoclopramide side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials.

Side effect videos
Nausea and VomitingDiarrheaFatigue

Monitoring

How often is monitoring needed?
Labs (blood tests) typically do not need to be monitored for metoclopramide, but may be checked before each chemotherapy treatment. Because the majority of each metoclopramide dose is eliminated in the urine, the serum creatinine (SCr) found in a comprehensive metabolic panel (CMP) may be used to assess how well your kidneys are working.

How often is imaging needed?
Although not required for everyone, your doctor may recommend an electrocardiogram (“ECG” or “EKG”) to check your heart rhythm as metoclopramide (Reglan®) can prolong the QTc interval and increase the risk of a heart arrhythmia.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue metoclopramide (Reglan®) as planned, add additional medications for nausea or vomiting, or switch to an alternative therapy if side effects are experienced and thought to be related to metoclopramide (Reglan®).

If the SCr is elevated, the kidneys may not be able to eliminate metoclopramide as quickly. This may lead to more side effects, such as sedation or sleepiness.

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

Questions to ask your Doctor Nurse Pharmacist

Questions to ask your Nurse Doctor Pharmacist

Questions to ask your Pharmacist Doctor Nurse

ChemoExperts Tips

You may take metoclopramide at the first sign of nausea. Its important not to wait until the nausea gets too severe to take your dose as it takes approximately 30 minutes for the drug to work and if vomiting occurs before then, you may end up vomiting up your dose of metoclopramide
Metoclopramide speeds up the movement of the intestine and moves liquid and food through the digestive tract faster which may lead to diarrhea
Unless instructed by your doctor, metoclopramide should not be taken during periods of severe constipation due to the risk of causing the lining of the intestine to break down (known as a perforation), which can lead to bleeding or infection
Metoclopramide may cause muscle spasms or twitching in certain individuals. These involuntary movements are collectively referred to as “extrapyramidal symptoms", or “EPS.” A sub-type of EPS are called “dystonias.” which are muscle spasms of head or neck muscles, or tongue. Dystonias occur shortly after taking the first dose of metoclopramide or in the first few days of treatment and usually resolve within 24 hours after the last dose of metoclopramide . At dosages of 40 mg per day or less, the risk of involuntary muscle twitching is estimated to affect 1 in 500 people
- If muscle spasms occur, stop taking metoclopramide and consider trying diphenhydramine (Benadryl®) available over-the-counter as a possible antidote. Diphenhydramine may be taken by following the directions on the package until the muscle spasms go away
- You should still contact your doctor if you experience any uncontrollable shaking or muscle movements, as this could be a sign of a serious side effect from metoclopramide
- Unless instructed by your doctor, limit use of metoclopramide to 12 weeks in total duration
- If possible, it is best to limit the amount of metoclopramide and the duration it is taken to decrease the risk of irreversible involuntary movements, known as tardive dyskinesia. The risk of tardive dyskinesia increases with higher metoclopramide doses and therapy longer than 12 weeks, and may not go away once the medication is stopped
If you experience excessive sleepiness while taking metoclopramide, ask your doctor or pharmacist if lowering the dosage may be appropriate
Do not take metoclopramide more frequently than prescribed as this increases the risk of experiencing side effects. You may use other anti-nausea medications such as ondansetron (Zofran®) if you are still experiencing nausea after taking metoclopramide
A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately. Additive sedating effects can be seen if metoclopramide is combines with alcohol, opioid pain medications, or sedatives such as lorazepam

Patient Assistance & Co-payment Coverage

References

Metoclopramide (Reglan®) package insert. Drug label information.

Created: January 4, 2018 Updated: January 4, 2018

What is Nausea and Vomiting?

What is nausea and vomiting?

Nausea is the uneasy feeling in the stomach that suggests that you may need to throw up. People often describe it as feeling “sick to the stomach” or “queasy.” Vomiting is when the stomach forcefully pushes its contents up and out through the mouth. A person can have nausea without vomiting, vomiting without much warning, or both.

What does nausea and vomiting look like?

Nausea may cause a person to look pale, sweaty, uncomfortable, or less interested in food. They may have a bad taste in their mouth, or certain smells may make them feel worse. Vomiting may happen once or repeatedly. Some people also have gagging, retching, stomach cramps, dizziness, or trouble keeping food and drinks down. If vomiting continues, the body can lose too much fluid, and the person can become dehydrated.

Who gets nausea and vomiting?

Anyone getting chemotherapy can have nausea or vomiting, but the chance is not the same for every treatment. Cancer treatments are grouped into different risk levels for nausea, which means how likely a drug or treatment regimen is to cause vomiting if no anti-nausea medicine is given. In general, high-risk chemotherapy causes vomiting in more than 90% of patients without prevention, moderate-risk causes it in 30% to 90%, low-risk in 10% to 30%, and minimal-risk in less than 10%. The risk level helps the care team choose how strong the prevention plan should be.

A person’s own body can also affect risk. Some people are simply more likely to feel sick from treatment than others. Prior problems with nausea, motion sickness, pregnancy-related nausea, or poor nausea control during an earlier chemotherapy cycle can all increase the risk of experiencing nausea/vomiting during treatment.

How do you prevent nausea and vomiting?

The main goal is to prevent nausea and vomiting because once symptoms begin, they can be harder to control. The timing of prevention also matters. Nausea risk can mainly be in the first 24 hours after chemotherapy, while some therapies can potentially cause nausea up to 5 days after treatment. This is why some anti-nausea medicines are given right before chemotherapy, while others may be continued for a few more days at home.
The medicines used most often belong to a few main groups:

5-HT3 blockers
- Ondansetron (Zofran®)
- Palonosetron (Aloxi®)
- Dolasetron (Anzemet®)
- Granisetron (Sancuso®, Kytril®)
Dexamethasone (Decadron®)
NK1 blockers
- Aprepitant (Emend®, Cinvanti®, Aponvie®)
- Fosaprepitant (Emend®, Focinvez®)
- Rolapitant (Varubi®)
- Netupitant (Akynzeo®)
- Fosnetupitant (Akynzeo®)
Olanzapine (Zyprexa®)

For high-risk chemotherapy, prevention usually consists of a 3 or 4-drug plan. This often includes a combination of a 5-HT3 blocker, dexamethasone, NK1 blocker, and/or olanzapine. For moderate-risk chemotherapy, prevention is usually a 2-drug plan for many regimens; however, some patients may need a 3-drug regimen. For low-risk chemotherapy, patients often receive just one medicine before treatment, such as dexamethasone or ondansetron. For minimal-risk chemotherapy, routine prevention medicine is often not needed, though rescue medicine may still be available if symptoms happen.

How is nausea and vomiting treated?

Even with good prevention, some patients still develop nausea or vomiting. When that happens, doctors often use a breakthrough treatment plan. “Breakthrough” means symptoms happen even though preventive medicine was already given. Commonly used medications for breakthrough symptoms include:

Olanzapine (Zyprexa®)
Cannabinoids
- Dronabinol (Marinol®)
Dopamine blockers
- Haloperidol (Haldol®)
- Metoclopramide (Reglan®)
- Prochlorperazine (Compazine®)
Histamine blockers
- Promethazine (Phenergan®)
- Scopolamine
5-HT3 blockers
- Ondansetron (Zofran®)
- Dolasetron (Anzemet®)
- Granisetron (Sancuso®, Kytril®)
Dexamethasone (Decadron®)
Lorazepam (Ativan®)

If nausea and vomiting keep happening over repeated cycles, the treatment plan may be changed for the next chemotherapy cycle. For example, the team may add olanzapine, add an NK1 blocker, switch the 5-HT3 blocker, or extend how long medicine is continued after treatment.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is the QTc interval?

The time it takes your heart to make one beat can be measured using an electrocardiogram (ECG, or EKG) and is reported as the QTc interval. Metoclopramide is generally safe to give when the QTc interval for men is less than 450 milliseconds per beat, and for women, less than 460 milliseconds per beat.

The QTc interval is prolonged if the heart takes too long to make the next beat, and could lead to a dangerous heartbeat known as an arrhythmia.

Certain medications, in addition to metoclopramide, may prolong the QTc interval. The list includes, but is not limited to: ondansetron (Zofran®), levofloxacin or ciprofloxacin antibiotics. Make sure your pharmacist checks all new medications to make sure they do not prolong the QTc interval.