Dosing: Adult

Gastroesophageal reflux: Oral: 10-15 mg/dose up to 4 times/day 30 minutes before meals or food and at bedtime; single doses of 20 mg are occasionally needed prior to provoking situations. Treatment >12 weeks is not recommended.

Diabetic gastroparesis:

Oral: 10 mg/dose up to 4 times/day 30 minutes before meals or food and at bedtime for 2-8 weeks

I.M., I.V. (for severe symptoms): 10 mg over 1-2 minutes; 10 days of I.V. therapy may be necessary before symptoms are controlled to allow transition to oral administration

Chemotherapy-induced emesis prophylaxis: I.V.: 1-2 mg/kg 30 minutes before chemotherapy and repeated every 2 hours for 2 doses, then every 3 hours for 3 doses (manufacturer labeling); pretreatment with diphenhydramine will decrease risk of extrapyramidal reactions

Alternate dosing: Note: Metoclopramide is considered an antiemetic with a low therapeutic index; use is generally reserved for agents with low emetogenic potential or in patients intolerant/refractory to first line antiemetics.

Low-risk chemotherapy (unlabeled): I.V., Oral: 10-40 mg prior to dose, then every 4-6 hours as needed (NCCN Antiemesis guidelines, v.4.2009)

Breakthrough treatment (unlabeled): I.V., Oral: 10-40 mg every 4-6 hours (NCCN Antiemesis guidelines, v.4.2009)

Delayed-emesis prophylaxis (unlabeled): Oral: 20-40 mg/dose (or 0.5 mg/kg/dose) 2-4 times/day for 3-4 days (in combination with dexamethasone [ASCO guidelines, 2006])

Refractory or intolerant to antiemetics with a higher therapeutic index (unlabeled; Hesketh, 2008):

I.V.: 1-2 mg/kg/dose before chemotherapy and repeat 2 hours after chemotherapy

Oral: 0.5 mg/kg every 6 hours on days 2-4

Postoperative nausea and vomiting prophylaxis: I.M., I.V. (unlabeled route): 10-20 mg near end of surgery. Note: Guidelines discourage use of 10 mg metoclopramide as being ineffective (Gan, 2007); comparative study indicates higher dose (20 mg) may be efficacious (Quaynor, 2002).

Postpyloric feeding tube placement, radiological exam: I.V.: 10 mg as a single dose

Dosing: Pediatric

(For additional information see "Metoclopramide: Pediatric drug information")

Gastroesophageal reflux (unlabeled use): Oral: 0.1-0.2 mg/kg/dose 4 times/day (maximum: 5 doses/day); pretreatment with diphenhydramine will decrease risk of extrapyramidal reactions to this dosage

Chemotherapy-induced emesis (unlabeled use): I.V.: 1-2 mg/kg 30 minutes before chemotherapy and every 2-4 hours

Postpyloric feeding tube placement: I.V.:

<6 years: 0.1 mg/kg as a single dose

6-14 years: 2.5-5 mg as a single dose

>14 years: Refer to adult dosing.

Dosing: Geriatric

Initial: Dose at the lower end of the recommended range. Refer to adult dosing.

Dosing: Renal Impairment

Clcr <40 mL/minute: Administer 50% of normal dose.

Not dialyzable (0% to 5%); supplemental dose is not necessary