Metoclopramide

What is metoclopramide?

Metoclopramide is a prescription-only medicine used to treat nausea and vomiting, commonly known by the brand name Maxolon. It is part of a group of drugs called dopamine antagonists[1]. 

What is metoclopramide used for?

Metoclopramide is an anti-sickness medicine used for or in[1]: 

• Nausea and vomiting due to illness, migraines, chemotherapy, radiotherapy, or after surgery 

• Gastroparesis (delayed stomach emptying), especially in people with diabetes 

• Acid reflux and indigestion when other treatments haven’t worked 

• Helping prepare for certain stomach and gut scans or tests 

• Palliative care 

Metoclopramide is also combined with painkillers such as aspirin (brand name Migramax) or paracetamol (brand name Paramax) for migraines. These are both prescription only. 

How does metoclopramide work?

Metoclopramide works by blocking dopamine receptors in the brain and gut, speeding up the movement of food through the stomach and intestines, and reducing the feeling of sickness by acting on the brain’s vomiting control centre (the CTZ – chemoreceptor trigger zone)[1]. 

Who can take metoclopramide?

Metoclopramide can be taken by adults and children over 1 year old (only under specialist advice)[1]. 

It may not be suitable if you[1]: 

• Have had involuntary movements (like tardive dyskinesia) 

• Have epilepsy or Parkinson’s disease 

• Have ever had stomach or intestinal bleeding 

• Have a slow heartbeat (bradycardia) 

• Have a tumour called pheochromocytoma 

• Have an adrenal gland tumour 

• Have a rare inherited blood disorder like porphyria, methaemoglobinemia, or NADH cytochrome-b5 deficiency 

• Have bowel obstruction, bleeding, or perforation 

• Are allergic to metoclopramide or any of its ingredients 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].

What is the typical dosage of metoclopramide?

The usual adult dose is 10mg up to three times a day, but it can vary depending on why you need metoclopramide. Treatment should not exceed 5 days (as per NHS guidelines) because of the risk of serious side effects[1].  

Long term use or high dose treatment of metoclopramide has been restricted after a review by the European Medicines Agency’s Committee on Medicinal Products for Human Use due to the risk of serious neurological effects. Therefore, in adults aged over 18 years, metoclopramide should only be used for prevention of postoperative nausea and vomiting, radiotherapy-induced nausea and vomiting, delayed (but not acute) chemotherapy-induced nausea and vomiting, and symptomatic treatment of nausea and vomiting, including that associated with acute migraine (where it may also be used to improve absorption of oral analgesics)[3]. 

Metoclopramide should only be prescribed for short-term use (up to 5 days). Intravenous doses should be administered as a slow bolus over at least 3 minutes. Oral liquid formulations should be given via an oral syringe for dose accuracy. This advice does not apply to the unlicensed use of metoclopramide in palliative care. Always follow your doctor’s or pharmacist’s instructions[3]. 

How do you take metoclopramide?

Metoclopramide is available as[1]: 

• Tablets (swallowed with water) 

• Liquid (measured with a syringe or dosing spoon) 

Take it with or after food, with at least a 30-minute  and try to space out doses evenly throughout 24 hours. If you’re taking the liquid, use the plastic syringe or medicine spoon that comes with the medicine. Do not use a kitchen teaspoon as it will not measure the correct amount[1].

Can you stop taking metoclopramide?

Yes, but if you’ve been taking it regularly, don’t stop suddenly without speaking to your doctor. Stopping abruptly may cause your symptoms to return. Your doctor may advise tapering the dose if needed[1]. 

What do you do if you take too much metoclopramide?

Taking one extra dose is unlikely to be harmful, but taking more metoclopramide than this can cause serious side effects, including[1]: 

• Drowsiness 

• Uncontrolled muscle movements (especially in the face or limbs) 

• Confusion, shaking, tremors, or agitation 

• Hallucinations 

If this happens, call 999 or go to A&E immediately. Bring the medicine packaging with you.

What if you forget a dose of metoclopramide?

If you miss a dose, take it as soon as you remember. If it’s nearly time for your next dose, skip the missed one. Do not take two doses at once[1]. 

Medicines you can and can’t take with metoclopramide

Metoclopramide can interact with other medicines. Avoid combining it with[1]: 

• Antipsychotics like haloperidol (increased risk of movement side effects) 

• Parkinson’s disease medication like evodopa or dopamine agonists (they work against each other) 

• Other anti-sickness medicines 

• Sedatives like diazepam or amitriptyline, or alcohol (increased drowsiness) 

• Opioid painkillers (they may reduce gut movement, counteracting metoclopramide) 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2].

What are the side effects of metoclopramide?

The most common side effects include[1]: 

• Drowsiness or tiredness 

• Low mood 

• Dizziness or feeling faint (low blood pressure) 

• Diarrhoea 

Rarer, but more serious side effects include[1]: 

• Involuntary muscle movements (e.g., twitching or jerking) 

• Neuroleptic Malignant Syndrome (a rare but serious condition with fever, stiffness, and confusion) 

• Seizure or fitting 

You should contact your doctor or NHS 111 if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about metoclopramide

Can I drink alcohol while taking metoclopramide? 
No. Alcohol can increase the risk of drowsiness and other side effects[1]. 

Is metoclopramide safe during pregnancy? 
It is sometimes used for severe morning sickness, but only under medical advice. However there are other anti-sickness medicines that have fewer side effects and may be more suitable. Speak to your doctor or pharmacist about which medicine would suit you best[1]. 

Can I drive or operate machinery while taking metoclopramide? 
Avoid driving if you feel drowsy or dizzy[1]. 

Is long-term use of metoclopramide safe? 
No. Metoclopramide should not be taken for longer than 5 days due to the risk of irreversible side effects[1]. 

For the official NHS guide to metoclopramide, visit their website.