D2 Antagonist·Gastrointestinal - Antiemetics

Metoclopramide

Nausea/vomiting, gastroparesis, migraine-associated nausea

PBSPROKINETICMaxolon, Pramin10 mg tabletS4+1

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At a glance

Max Dose

30 mg/day

Half-life

5-6 h

Caution: EPSE / Akathisia

HIGH RISK

High risk: Bowel Obstruction

CONTRAIND.

Cautions

Avoid / Cautions

Mechanical bowel obstruction, GI perforation/haemorrhage, Parkinson's disease, history of tardive dyskinesia. Pregnancy Category A.

Where it stands

Rapid Summary

Overview

Central D2 receptor antagonist with peripheral prokinetic properties. Excellent for nausea related to migraines, gastroparesis, and opioid use.

Clinical Focus

Never use in patients with bowel obstruction. Limit use to < 5 days to prevent tardive dyskinesia.

Bottom Line

Metoclopramide is an effective prokinetic antiemetic for gastroparesis and post-operative nausea, but carries serious risk of extrapyramidal side effects especially in young women and must be limited to 5 days.

Formulation & Access

Brand Names

Maxolon, Pramin

Oral Routes

Tablets (10 mg).

Parenteral

Ampoules (10 mg/2 mL) for IV / IM.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Nausea/vomiting, gastroparesis, migraine-associated nausea.

Clinical Place

First-line prokinetic antiemetic. Highly effective for opioid-induced nausea (which stimulates the chemoreceptor trigger zone).

Quick reference

Class & Role

D2 Antagonist — Central D2 receptor antagonist with peripheral prokinetic properties.

Route / Formulation

Tablets (10 mg). (Maxolon, Pramin)

Usual Dose & Max

PO / IV / IM 10 mg up to TDS. Max 30 mg/day.

Key Indication Doses

Nausea / Vomiting: PO / IV / IM 10 mg up to TDS. Max 30 mg/day. Diabetic Gastroparesis: PO 10 mg TDS, 30 mins before meals. Elderly / Renal: Max 5 mg per dose to prevent severe EPSE and confusion.

Best Uses

Key Risks

Neurological: Extrapyramidal side effects (EPSE): acute dystonia (oculogyric crisis, torticollis), severe akathisia (restlessness). Tardive dyskinesia with chronic use. Cardiovascular: Hypotension, rare bradycardia if pushed too fast IV. Endocrine: Hyperprolactinemia (galactorrhea).

Key Interactions

Antipsychotics (Haloperidol, Risperidone). Massively amplifies EPSE and Neuroleptic Malignant Syndrome (NMS) risk. Anticholinergics (e.g., Amitriptyline) completely cancel out the prokinetic gut effects of metoclopramide.

Monitoring

Monitor for akathisia. If a patient starts pacing the ward or pulling out their IV lines after a dose, it is akathisia, not 'anxiety'. Check eGFR to guide dose reduction.

Clinical Pearl

Because metoclopramide forces the stomach and bowel to contract (prokinetic), giving it to a patient with a mechanical bowel obstruction can cause a catastrophic bowel perforation. Use Ondansetron instead.

Access

Maxolon, Pramin10 mg tablet

Brand: Maxolon, Pramin
Formulation: Tablets (10 mg).

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