1.
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.
