Metoclopramide is a prokinetic agent that increases muscle tone of the lower esophagus sphincter. The lower esophagus sphincter located between the esophagus and stomach normally prevents reflux of acid and other stomach contents into the esophagus. In patients with Gastroesophageal Reflux GERD a weakened lower esophagus sphincter allows reflux of stomach acid into the esophagus causing heart burn and acid damage to the esophagus peptic esophagitis. Metoclopramide decreases stomach acid reflux by strengthening the lower esophagus sphincter. Like cisapride Propulsid metoclopramide also hastens the stomach emptying of solid and liquid meals into the intestines. Rapid emptying of meals also help decrease the reflux of stomach acid and other contents into the esophagus.

Metoclopramide interferes with dopamine receptors in the brain. Since dopamine causes nausea. Metoclopramide can be an effective anti-nausea medication.

While cisapride and metoclopramide are similar in decreasing gastroesophageal reflux metoclopramide is more likely to cause nervous system side effects such as jitteriness insomnia sedation or anxiety.

Metoclopramide is usually given four times daily 30 minutes before each meal and at bedtime for the treatment of esophageal reflux. Dosage and frequency may be lowered in elderly patients and in situations where symptoms occur only intermittently and at specific times. Concurrent administration of Anticholinergic medications can decrease the effectiveness of metoclopramide.

Metoclopramide is generally well tolerated when used in low doses for brief periods. The nervous system side effects increase with higher doses and longer periods of treatment. The common side effects are mentioned above under Drug Interactions.

Metoclopramide can have nervous system side effects such as depression anxiety sedation restlessness and insomnia. Parkinson patients can experience worsening of symptoms with metoclopramide. Metoclopramide may impair the mental and/or physical abilities to drive or operate machinery. Rarely metoclopramide can cause involuntary muscle movements facial grimacing and dystonic reactions resembling tetanus. Since metoclopramide accelerates stomach emptying it can increase absorption and effects of other medications. For example the effects of sedatives such as alcohol and diazepam Valium can be accelerated when used together with metoclopramide. Safety in pregnancy nursing mothers and children has not been established.

Metoclopramide is used on a short term basis 4 to 12 weeks for patients with heartburn and esophagitis due to gastroesophageal reflux. Please also read the Gastroesophageal Reflux GERD article. Stomach nerve damage due to diabetes diabetic gastric stasis can cause delayed stomach emptying resulting in nausea vomiting fullness and heartburn. Metoclopramide can be effective in relieving nausea and other symptoms related to diabetic gastric stasis. Metoclopramide is also used in the treatment of nausea related to postoperative state and cancer chemotherapy.

Tablets and syrup should be stored at temperature between 15-30C
59-86F.