Indications: A gastrointestinal prokinetic agents used for the treatment of diabetic gastroparesis, symptomatic gastro- esophageal reflux, prevention of chemotherapy induced nausea and vomiting, small bowl intubation, radiological examination.
Pharmacology - The primary pharmacologic effects of metoclopramide are associated with the GI tract and the CNS. In the GI tract, metoclopramide stimulates motility of the upper GI without stimulating gastric, pancreatic or biliary secretions. While the exact mechanisms for these actions are unknown, it appears that metoclopramide sensitizes upper GI smooth muscle to the effects of acetylcholine. Intact vagal innervation is not necessary for enhanced motility, but anticholinergic drugs will negate metoclopramide’s effects. Gastrointestinal effects seen include increased tone and amplitude of gastric contractions, relaxed pyloric sphincter, and increased duodenal and jejunal peristalsis. Gastric emptying and intestinal transit times can be significantly reduced. There is little or no effect on colon motility. Additionally, metoclopramide will increase lower esophageal sphincter pressure and prevent or reduce gastroesophageal reflux. The above actions evidently give metoclopramide its local antiemetic effects.
In the CNS, metoclopramide apparently antagonizes dopamine at the receptor sites. This action can explain its sedative, central anti-emetic (blocks dopamine in the chemo-receptor trigger zone), extrapyrimidal, and prolactin secretion stimulation effects.
Doses & Administrations:
Oral: Adult: 10mg three times daily before meal, for nausea vomiting and dyspepsia. For prolactin test: 10mg PO, draw level at 60, 90 and 120 minutes Pediatric: Children under 1 year : 1mg twice daily. Children 1-3 years : 1mg two-three times daily. Children 3-5 years : 2mg two-three daily. Children 5-9 years : 2.5mg three times daily. Children 9 to 14 years : 5mg three times daily. Children 15-19 years : 5-10mg three times daily. Parenteral (I/M or I/V): Adult: Same as oral dose. Pediatric: Same as oral dose. For cytotoxic drugs induced nausea and vomiting, the intravenous (infusion) dose is 1-2mg/kg 30 minutes before chemotherapy and repeated every 2 t 4 hours to a maximum of 10mg/kg daily.
Contra Indications:
Hypersensitivity to metoclopromide, patients with pheochromocytoma, G.I hemorrhage, G.I obstructions.
Precautions:
Patients with epilepsy, parkinson's disease, depression, elderly and young patient.
Pregnancy Status:
Category"B"
Renal Failure Doses:
GFR (ml/min) Dose >50 no dose adjustment is required 10-50 75% of usual dose <10 50% of usual dose
Lactation Status:
Unknown.
Interactions:
Should be used with caution in patients receiving MAO- inhibitors, tricyclic antidepressants, sympathomimetic amines.
Adverse Effects:
Drowsiness, extrapyramidal reactions, hypotension, diarrhea, galactorrhea.
How Do Give
Monitor BP carefully during IV administration. - Watch for extrapyamidal symptoms (neck stiffness, staggening gait and muscular spasm). - Administer 1/2 hours before meal for better absorption. - Monitor Diabetic patients, and arrange for alteration in insulin dose or timing. - Arrange phentolamine on standby in case of hypertensive crises. - IV DILUTION: Dilute all doses in 50 ml D5W give over 30 min.
Sources:
http://www.rxlist.com/cgi/generic/metopxl.htm
Drugs.com http://www.drugs.com/metoprolol.html
Wikipedia http://en.wikipedia.org/wiki/Metoprolol
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Ditulis oleh:
Unknown - Tuesday, 16 August 2011
