Metoclopramide Hydrochloride

Adults: Metoclopramide spray: for adults under 65 years of age, the recommended dose is 1 spray (15 mg) in one nostril, 30 minutes before each meal and at bedtime (maximum of 4 sprays daily), continued for 2 to 8 weeks depending on symptomatic response. For adults aged 65 years and older, metoclopramide is not recommended as initial therapy in geriatric patients. Geriatric patients who are already receiving an alternative metoclopramide product at a stable dose of 10 mg four times daily can be switched to 1 spray (15 mg) of metoclopramide in one nostril, 30 minutes before each meal and at bedtime (maximum four times daily), for 2 to 8 weeks depending on symptomatic response. Metoclopramide tablet: for gastroesophageal reflux, metoclopramide may be given continuously or intermittently. Continuous treatment is 10 to 15 mg, 30 minutes before each meal and at bedtime (maximum of 60 mg per day), for 4 to 12 weeks. Intermittent treatment is a single dose of up to 20 mg taken before a provoking situation. For acute and recurrent diabetic gastroparesis, give 10 mg, 30 minutes before each meal and at bedtime (maximum of 40 mg per day), for 2 to 8 weeks. Metoclopramide injection: for the relief of symptoms associated with diabetic gastroparesis (diabetic gastric stasis), oral metoclopramide may be started if only the earliest manifestations of diabetic gastric stasis are present. If severe symptoms are present, however, therapy should begin with metoclopramide injection (IM or IV). Doses of 10 mg may be given slowly by the intravenous route over a period of 1 to 2 minutes. Metoclopramide injection (metoclopramide injection, USP) may need to be given for up to 10 days before symptoms subside, at which point oral metoclopramide may be started. The physician should carefully assess the risks and benefits before prescribing further metoclopramide treatment. For the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, intravenous infusions should be given slowly over a period of not less than 15 minutes, starting 30 minutes before cancer chemotherapy begins, and repeated every 2 hours for two doses, then every 3 hours for three doses. The first two doses should be 2 mg/kg when highly emetogenic drugs such as cisplatin or dacarbazine are used alone or in combination. For less emetogenic regimens, 1 mg/kg per dose may be adequate. For the prevention of postoperative nausea and vomiting, metoclopramide injection should be given intramuscularly near the end of surgery. The usual adult dose is 10 mg, although doses of 20 mg may be used.