Section 19 · Monograph

Metoclopramide

Reviewed Nov 2026FDA label

ReglanD2 antagonist prokinetic

Forms: Tab: 5, 10mg | ODT: 5, 10mg | Soln: 5mg/5mL | Inj: 5mg/mL
Dose: Gastroparesis or nausea: 5-10mg 30 min before meals and at bedtime; avoid beyond 12 weeks; avoid in Parkinson's disease
MOA: D2 and 5-HT3 blockade, 5-HT4 agonism

Black Box Warning

Treatment with metoclopramide can cause tardive dyskinesia (TD), a serious and often irreversible movement disorder
Risk of TD increases with duration of treatment and total cumulative dose
Avoid treatment durations longer than 12 weeks except in rare cases where therapeutic benefit is judged to outweigh the risk of developing TD
Discontinue immediately if signs or symptoms of TD appear; symptoms may worsen or become irreversible even after discontinuation

Short-term (4–12 weeks) therapy for symptomatic gastroesophageal reflux (GERD) in adults who fail conventional therapyFDA-labeled
Relief of symptoms associated with acute and recurrent diabetic gastroparesisFDA-labeled
In migraine care, used off-label as an antiemetic/prokinetic adjunct to improve gastric absorption of oral abortive agents and to treat nauseaFDA-labeled

Adjunctive antiemetic and prokinetic agent for acute migraine attacks (IV/IM in ED settings, or oral adjunct to abortive therapy)Off-label
Treatment of migraine-associated nausea/vomiting and gastric stasis limiting absorption of oral migraine medicationsOff-label

Central and peripheral dopamine D2-receptor antagonist, accounting for antiemetic effects (chemoreceptor trigger zone) and central extrapyramidal side effects
Stimulates motility of the upper GI tract (increases lower esophageal sphincter tone, gastric/duodenal contractions) without stimulating gastric, biliary, or pancreatic secretions
Sensitizes GI smooth muscle to the effects of acetylcholine
In migraine, prokinetic effect helps counteract migraine-associated gastroparesis, improving absorption of co-administered oral analgesics/triptans

GERD: 10–15 mg orally up to 4 times daily, 30 minutes before meals and at bedtime, for up to 12 weeks
Diabetic gastroparesis: 10 mg orally 30 minutes before each meal and at bedtime for 2–8 weeks, as symptoms warrant
Migraine adjunct (off-label, typical practice dosing): 10 mg IV/IM or oral as an antiemetic; administer slow IV push over ≥1–2 minutes to reduce risk of akathisia/restlessness
Not recommended for chronic or maintenance use due to tardive dyskinesia risk

Renal impairment: initiate at approximately half the recommended dose when creatinine clearance is <40 mL/min

Gastrointestinal hemorrhage, mechanical obstruction, or perforation (risk of increased GI motility complications)
Pheochromocytoma or history of pheochromocytoma (risk of hypertensive crisis)
History of tardive dyskinesia or dystonic reaction to metoclopramide
Epilepsy or use with other drugs likely to cause extrapyramidal reactions (increased seizure frequency/severity)
Known hypersensitivity or intolerance to metoclopramide

Anticholinergic drugs and opioid/narcotic analgesics antagonize metoclopramide's GI motility effects
Additive CNS depression/sedation with alcohol, sedatives, hypnotics, narcotics, and tranquilizers
Use with MAO inhibitors may cause release of catecholamines — use cautiously
Concurrent use with other drugs causing extrapyramidal reactions (e.g., antipsychotics) increases risk and severity of EPS/TD — avoid combination
Alters GI absorption of other oral drugs: decreases absorption of digoxin; increases rate/extent of absorption of acetaminophen, tetracycline, levodopa, ethanol, and cyclosporine
May require adjustment of insulin dose/timing due to altered rate of gastric emptying and food delivery to the small intestine

CNS: restlessness, drowsiness, and fatigue (~10% at standard doses); less commonly insomnia, headache, confusion, dizziness
Depression, including rare reports of suicidal ideation/behavior
Extrapyramidal symptoms: acute dystonic reactions (~0.2%, more common in younger patients and at higher doses), parkinsonian symptoms, akathisia
Tardive dyskinesia with prolonged use (see boxed warning)
Neuroleptic malignant syndrome (rare, potentially fatal)
Endocrine: galactorrhea, amenorrhea, gynecomastia (due to prolactin elevation)
Cardiovascular: hypotension, hypertension, fluid retention (rare)
GI: nausea, diarrhea, bowel disturbances
Methemoglobinemia, particularly in neonates given excessive doses
Hypersensitivity reactions

Assess for early signs of tardive dyskinesia (e.g., involuntary rhythmic movements of tongue, face, mouth, jaw) at baseline and periodically during treatment
Limit duration of use and reassess need for continued therapy; avoid >12 weeks of use
Monitor for depression, mood changes, and suicidal ideation
Monitor blood pressure, especially in patients with hypertension or pheochromocytoma risk
Monitor for extrapyramidal symptoms, especially in children, young adults, and at higher doses
In diabetics, monitor blood glucose and adjust insulin regimen as gastric emptying changes
Assess renal function; adjust dose if creatinine clearance <40 mL/min

Pregnancy: Available data have not identified a drug-associated risk of major birth defects or miscarriage; animal reproduction studies did not show fetal harm at doses well above human exposure
Use during pregnancy only if the potential benefit justifies the potential risk to the fetus
Lactation: Metoclopramide is present in breast milk; caution is advised due to reports of adverse effects (e.g., irritability) in some breastfed infants
Weigh developmental and health benefits of breastfeeding against the mother's clinical need for metoclopramide and any potential adverse effects on the breastfed infant