Pharmacology. Metoclopramide is a dopamine antagonist with antiemetic activity at the chemoreceptor trigger zone. It also accelerates GI motility and facilitates gastric emptying. The onset of effect is 1–3 minutes after intravenous administration, and therapeutic effects persist for 1–2 hours after a single dose. The drug is excreted primarily by the kidneys. The elimination half-life is about 5–6 hours but may be as long as 14.8 hours in patients with renal insufficiency and 15.4 hours in patients with cirrhosis.

Indications

1. 
   

   Metoclopramide is used to prevent and control persistent nausea and vomiting, particularly when the ability to administer activated charcoal (eg, treatment of theophylline poisoning) or another oral antidotal therapy (eg, acetylcysteine for acetaminophen poisoning) is compromised.

   
   
2. 
   

   Theoretic (unproven) use to stimulate bowel activity in patients with ileus who require repeat-dose activated charcoal or whole-bowel irrigation.

Contraindications

1. 
   

   Known hypersensitivity to the drug; possible cross-sensitivity with procainamide.

   
   
2. 
   

   Mechanical bowel obstruction or intestinal perforation.

   
   
3. 
   

   Pheochromocytoma (metoclopramide may cause hypertensive crisis).

Adverse effects

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