Metoclopramide (Maxeran®)

Section 1.1

Midwives may independently prescribe, order and administer this drug.

(Maxeran®) is a dopamine receptor antagonist which works in the chemoreceptor trigger zone of the brain thereby reducing emesis, increasing gastric emptying and intestinal muscle contractions, and increasing the tone of the lower esophageal sphincter.

Indications and Clinical Use:

Primarily indicated in adults for symptomatic short-term treatment of delayed gastric emptying, gastroesophageal reflux, and nausea and vomiting. Metoclopramide can be administered during pregnancy and labour for the treatment of nausea, vomiting and hyperemesis (see CMBC’s Indications for Discussion, Consult and Transfer of Care).

Contraindications:

Hypersensitivity or known allergy to metoclopramide; when stimulation of gastro-intestinal motility may cause hemorrhage, perforation or obstruction of GIT; history of seizure disorder.

Warnings and Precautions:

Metoclopramide is also a prolactin stimulant and may increase milk production. It is not within the midwife scope to prescribe metoclopramide as a galactagogue. (Domperidone is the preferred medication in Canada.)

Pregnancy:

Compatible

Lactation:

Category L2 – Significant Data – Compatible

Adverse Reactions:

Drowsiness, GI disturbances, constipation or diarrhea, hyper/hypotension, high doses in young people may cause extrapyramidal or dystonic reactions (potentially reversed with diphenhydramine Benadryl®).

Dosage and Administration:

Oral: 5-10 mg/dose q8h.

IV/IM: 5-10 mg IV or IM q8h. Administer IV injection slowly, maximum rate 10 mg over 2 minutes; or may dilute 10 mg with 50 mL of NS and infuse slowly over 15-30 minutes.

Onset of Action:

Oral: 30-60 minutes;
Intramuscular: 10 to 15 minutes;
Intravenous: 1 to 3 minutes

Half-life:

5 to 6 hours