A nurse is assessing a client who received a preoperative IV dose of metoclopramide 1 hr ago

VOL: 101, ISSUE: 12, PAGE NO: 37

Generic and proprietary names

- Metoclopramide: Maxolon; Maxolon High Dose; Maxolon SR; Gastrobid Continus.

Action

- Cholinergic.

- Anti-emetic.

- Central dopamine receptor agonist.

- Enhances response to acetylcholine of tissue in the upper gastrointestinal tract, which results in contraction of gastric muscle.

- Relaxes pyloric duodenal segments.

- Increases peristalsis without stimulating secretions.

- Blocks dopamine in chemoreceptor trigger zone of central nervous system.

Indications

- Nausea and vomiting, particulary in gastrointestinal disorders and during treatment with cytotoxics or radiotherapy.

- Migraine.

Contraindications

- Gastrointestinal obstruction, perforation or haemorrhage.

- Three to four days post gastrointestinal surgery.

- Phaeochromocytoma.

- Breastfeeding.

Cautions

- Hepatic and renal impairment.

- Older people.

- Young adults and children (the dose must be measured accurately with a pipette).

- Symptoms can mask underlying disorders such as cerebral irritation.

- Epilepsy.

- Pregnancy.

- Porphyria.

Side-effects

- Extrapyramidal effects (especially in children and young adults).

- Hyperprolactinaemia.

- Tardive dyskinesia can occur with prolonged treatment.

- Drowsiness.

- Restlessness.

- Diarrhoea.

- Depression.

- Neuroleptic malignant syndrome.

- Rashes.

- Pruritis.

- Oedema.

- Cardiac conduction abnormalities have been reported after intravenous administration.

Rare Side-effects

- Methaemoglobinaemia.

Interactions

- Enhances effect of some analgesics.

- Antipsychotics: increased risk of extrapyramidal symptoms.

- Increased sedation in alcohol and other central nervous system depressants.

- Antimuscarinics: antagonism of effect on gastrointestinal activity.

Administration

- Oral, intravenous or intramuscular.

Nursing considerations

- Assess for extrapyramidal symptoms and tardive dyskinesia (more likely in older patients).

- Assess for gastrointestinal complaints, such as nausea, vomiting and constipation.

- In oral administration, for better absorption allow 30 minutes to one hour before eating.

- Rinse mouth frequently to combat dryness.

Patient teaching

- Metoclopramide can cause drowsiness. Patient should avoid hazardous activities until stabilised.

- Store in a closed container in a cool place out of the reach of children.

- If there is nausea, fatty and spicy foods should be avoided.

- Avoid alcohol or other central nervous system depressants.

- If a dose is missed, the patient should take it as soon as possible. If the next dose is due within the next three hours, she or he should take a single dose immediately and skip the next one.

- The drug can be safely stopped as soon as a patient no longer needs it.

- An occasional unintentional extra dose is unlikely to cause harm.

- A large overdose could cause drowsiness and muscle spasms. A doctor should be notified.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines