Metoclopramide

Medically Reviewed by Dr. J.R.G. Peries, M.D – Cardiology

Last Reviewed: Apr 26, 2023

Warnings

Metoclopramide Risks, Warnings, and Complications

Metoclopramide can cause serious problems in some people. Talk to your doctor or pharmacist about other treatment options if you are at increased risk of complications from metoclopramide use.

TARDIVE DYSKINESIA: Metoclopramide can lead to a serious movement disorder called tardive dyskinesia, in which there are uncontrolled movements of the face, tongue, and other parts of the body. Tell your doctor right away if you notice any uncontrollable body movements, particularly lip-smacking, mouth puckering, chewing, frowning, scowling, sticking out your tongue, blinking, eye movements, or shaking arms or legs. The risk is higher in older adults, especially females, people with a history of diabetes, and those using this medication for longer than 12 weeks. Your risk of this very serious condition (tardive dyskinesia) is also higher if you take other medications that might also cause this side effect, such as haloperidol (Haldol), prochlorperazine, carbidopa/levodopa (Sinemet) or fluoxetine (Prozac). You should avoid taking metoclopramide (Reglan) if you are using these medications.
OTHER CONDITIONS WITH UNCONTROLLED MUSCLE MOVEMENTS (PARKINSONIAN SYMPTOMS, MOTOR RESTLESSNESS AND EXTRAPYRAMIDAL REACTIONS OR SYMPTOMS SUCH AS DYSTONIC REACTIONS): Metoclopramide can result in other unusual uncontrolled movements of muscle in addition to tardive dyskinesia, such as recurrent twisting and stiffening of muscles, jitteriness tremors, pacing, and foot tapping. The risk is higher if your age is less than 30 years, if you are taking higher than recommended dosages, if you are taking medications for Parkinson's disease, or taking antipsychotic medications. Symptoms are usually noted in the initial six months though they can start as soon as the first 24 to 48 hours after starting metoclopramide. If you notice these symptoms, stop the medication and seek medical help immediately. When you stop taking the drug, symptoms usually go away, but for some patients, it may take up to three months for these symptoms to completely subside. In some circumstances, if the benefit outweighs the risk, your doctor might ask you to resume taking metoclopramide.
NEUROLEPTIC MALIGNANT SYNDROME: Very rarely, metoclopramide can lead to a serious brain disorder called neuroleptic malignant syndrome. Signs and symptoms of this condition include high fever, muscle stiffness, excessive sweating, confusion, and changes in heart rate and blood pressure. The risk is more in individuals who are also taking antipsychotic medications. Get medical help right away if you experience these symptoms, as they can be life-threatening.
DEPRESSION AND SUICIDAL THOUGHTS: Even in individuals who have no history of depression, metoclopramide can lead to depression or mental illness. If you experience any unusual mood changes, suicidal thoughts, or feel the desire to harm yourself, speak with your healthcare professional.
HIGH BLOOD PRESSURE: Metoclopramide can lead to an increase in blood pressure. The risk is higher if you are also taking other medications that increase your blood pressure, such as monoamine oxidase inhibitors (MAOI), antidepressants such as phenelzine (Nardil), isocarboxazid (Marplan), or selegiline (Eldepryl). Tell your doctor if you notice variations in your blood pressure.
FLUID RETENTION: Metoclopramide may increase aldosterone levels, a hormone that causes water retention in your body. This causes swelling in the arms, legs, or around the stomach. The risk is higher in people who have heart failure or liver disease. Call your doctor if you develop sudden weight gain or any swelling in your body.
INCREASED PROLACTIN LEVELS: Metoclopramide can lead to an increase in prolactin levels. High levels of this hormone can cause fertility problems, milky nipple discharge, enlargement of male breasts, absent or irregular menstrual periods in females, sexual dysfunction, and weakening of the bones. Your healthcare provider may order blood tests on a regular basis to keep an eye on your prolactin levels.

Precautions Before Starting Metoclopramide

Tell your doctor if you have ever had an allergic reaction to metoclopramide, any of the active or inactive ingredients in metoclopramide dosage forms, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Metoclopramide may not be right for people with certain medical conditions such as phenylketonuria, Parkinson’s disease and other problems with muscle movements, high blood pressure, breast cancer, blockage, bleeding, or a tear in your stomach or intestines, depression, asthma, glucose-6-phosphate dehydrogenase (G-6PD) deficiency, NADH cytochrome B5 reductase deficiency, heart, liver, or kidney disease.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Metoclopramide

Keep all your doctors’ appointments while taking metoclopramide. Your doctor may want to order certain laboratory tests on a regular basis during your treatment with this medicine.

Metoclopramide can make you drowsy and dizzy. Do not drive a car or operate machinery until you know how it affects you. Avoid drinking alcohol or smoking while on this medicine because it can make these side effects worse. Do not sit or stand up quickly, particularly if you are an older patient. This decreases the risk of dizziness or fainting spells.

If you are taking metoclopramide for the treatment of symptoms of slow stomach emptying caused by diabetes, you should be aware that your symptoms will not show improvement all at once. Your nausea improves in the early phase of your treatment, and it gets better over the next three weeks. Reduced appetite and vomiting may also show improvement early on, but it might take longer for your feeling of fullness to recover. Make sure you do not use this medication for more than 12 weeks.

Tell your doctor if you become pregnant while on metoclopramide

Be sure to tell all your doctors you are on metoclopramide before any surgery, including dental procedures.

Even if you feel well, continue taking metoclopramide. Without consulting your doctor, do not discontinue taking metoclopramide. When you stop using metoclopramide, you can suffer withdrawal symptoms such as nervousness, dizziness, and headache.

If you are 65 years of age or older, talk about the benefits and drawbacks of taking metoclopramide with your doctor. Metoclopramide is not as safe or as effective as other medications that can be used to treat those conditions. Thus, older persons should generally avoid using it unless it is used to treat delayed stomach emptying.

Metoclopramide Drug Interactions

Certain other drugs can affect how metoclopramide works. Possible interactions between metoclopramide and other medicines can increase the risk of severe adverse effects. The following medications can have possible interactions with metoclopramide:

Acetaminophen (Tylenol, others)
Antihistamines
Aspirin
Atropine (in Lonox, in Lomotil)
Cyclosporine (Gengraf, Neoral, Sandimmune)
Barbiturates such as pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal)
Monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), and tranylcypromine (Parnate)
Digoxin (Lanoxicaps, Lanoxin)
Haloperidol (Haldol)
Insulin
Ipratropium (Atrovent)
Lithium (Eskalith, Lithobid)
Levodopa (in Sinemet, in Stalevo)
Tetracycline (Bristacycline, Sumycin)
Medications used to treat anxiety
Medications for irritable bowel disease
Medications for nausea and motion sickness
Medications for ulcers
Medications for urinary problems;
Narcotic medications for pain
Medications used to treat Parkinson’s disease
Medications used to treat high blood pressure
Sleeping pills, sedatives and tranquilizers

The above list may not describe all possible interactions of metoclopramide. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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