Reglan

Reglan (metoclopramide hydrochloride) is a prescription medication indicated for the short-term treatment of adults with diabetic gastroparesis and for the relief of symptoms associated with gastroesophageal reflux disease (GERD) when conventional therapy has been inadequate. As a dopamine antagonist and prokinetic agent, it works by increasing the contractions of the stomach and intestines, facilitating gastric emptying, and strengthening the lower esophageal sphincter. This action provides targeted relief from nausea, vomiting, heartburn, and the feeling of prolonged fullness after meals. Its use is supported by clinical guidelines for specific gastrointestinal motility disorders under careful medical supervision.

Features

• Active ingredient: Metoclopramide hydrochloride
• Available in 5 mg and 10 mg immediate-release tablets
• Also available in oral solution and injectable forms
• Dopamine D2 receptor antagonist
• Serotonin 5-HT3 receptor antagonist
• Prokinetic agent (enhances gastrointestinal motility)
• Anti-emetic properties

Benefits

• Accelerates gastric emptying and intestinal transit, providing relief from the discomfort of gastroparesis.
• Reduces the frequency and severity of nausea and vomiting associated with delayed gastric emptying.
• Alleviates symptoms of gastroesophageal reflux disease (GERD), including heartburn and regurgitation, by strengthening the esophageal sphincter.
• Helps restore a more normal digestive process for improved nutritional intake and quality of life.
• Offers a therapeutic option for patients who have not responded adequately to first-line treatments like acid suppressants or dietary modifications.

Common use

Reglan is primarily prescribed for two main conditions. The first is diabetic gastroparesis, a condition where high blood sugar levels damage the vagus nerve, leading to delayed stomach emptying. This causes symptoms like nausea, early satiety, postprandial fullness, bloating, and vomiting. The second common use is for the short-term therapy (4 to 12 weeks) of symptomatic GERD in adults who experience heartburn and regurgitation that has not been sufficiently controlled with other medications, such as proton pump inhibitors or H2 blockers. Its use is generally reserved for situations where the benefits are judged to outweigh the risk of potential neurological side effects.

Dosage and direction

Dosage is individualized based on the condition being treated and the patient’s response. For diabetic gastroparesis in adults, the usual dosage is 10 mg taken 30 minutes before each meal and at bedtime for 2 to 8 weeks. Therapy should not exceed 12 weeks due to the increased risk of tardive dyskinesia. For GERD, the dosage is typically 10 mg to 15 mg up to four times daily, 30 minutes before meals and at bedtime. The oral solution should be measured with a dedicated dosing syringe or cup. The injectable form is administered in a clinical setting. It is crucial to follow the prescribing physician’s instructions exactly and not to adjust the dose or duration of therapy without consultation.

Precautions

Patients should be closely monitored for the development of tardive dyskinesia, a potentially irreversible movement disorder. The risk increases with longer treatment duration and higher total cumulative dose. Use should be avoided in the elderly, except in rare cases where gastroparesis symptoms are severely debilitating and other therapies have failed, as they are at greater risk. Reglan may cause drowsiness or impair mental and/or physical abilities required for tasks such as driving or operating machinery. Caution is advised in patients with depression, as the drug may exacerbate the condition. It should be used with caution in patients with a history of seizures or Parkinson’s disease. Patients should be advised to avoid alcohol while taking this medication.

Contraindications

Reglan is contraindicated in patients with:

• A known hypersensitivity or intolerance to metoclopramide or any components of the formulation.
• A history of tardive dyskinesia.
• Concomitant use of medicines that can cause tardive dyskinesia (e.g., antipsychotics).
• A pheochromocytoma due to the risk of hypertensive crisis.
• Gastrointestinal obstruction, perforation, or hemorrhage.
• Epilepsy (may increase seizure frequency).

Possible side effect

The most serious side effect is tardive dyskinesia, characterized by involuntary, repetitive movements of the face and body. Other common side effects include restlessness, drowsiness, fatigue, and lassitude. Patients may also experience insomnia, headache, dizziness, and nausea. Extrapyramidal symptoms (EPS) such as akathisia (inability to sit still), acute dystonic reactions (involuntary muscle contractions), and parkinsonian symptoms (tremor, rigidity) can occur, often at higher doses or in younger patients. Less frequently, it can cause depression, galactorrhea (milk secretion), menstrual irregularities, and hyperprolactinemia. Any unusual movements or mood changes should be reported to a physician immediately.

Drug interaction

Reglan has several important drug interactions. It should not be used with other drugs that cause extrapyramidal symptoms, such as antipsychotics (e.g., haloperidol, risperidone) and certain antiemetics (e.g., prochlorperazine), as this increases the risk of neurological side effects. It may antagonize the effects of dopamine agonists used in Parkinson’s disease (e.g., levodopa, pramipexole). Concomitant use with central nervous system depressants like alcohol, benzodiazepines, and opioids may result in additive sedative effects. It can affect the absorption of other orally administered drugs by altering gastrointestinal motility (e.g., increasing the absorption of digoxin, decreasing the absorption of cimetidine).

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Patients should not take a double dose to make up for a missed one. Maintaining a consistent schedule is important for efficacy, but occasional missed doses are not typically dangerous. If multiple doses are missed or a pattern develops, the prescribing physician should be consulted.

Overdose

Overdose of Reglan is primarily associated with its anti-dopaminergic effects. Symptoms may include drowsiness, disorientation, and extrapyramidal reactions (e.g., akathisia, dystonia, parkinsonism). In severe cases, seizures, cardiac conduction abnormalities, and methemoglobinemia have been reported. There is no specific antidote. Management involves immediate discontinuation of the drug, supportive care, and symptomatic treatment. Benzodiazepines may be used to control acute dystonic reactions. Gastric lavage may be considered if presentation is early. In case of suspected overdose, contact a poison control center or seek emergency medical attention immediately.

Storage

Store Reglan tablets and oral solution at room temperature, between 20°C to 25°C (68°F to 77°F). The medication should be kept in its original container, tightly closed, and protected from light and moisture. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them down a drain unless instructed to do so. Properly discard any expired or unused medication through a medicine take-back program.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has not been evaluated by all regulatory agencies and is intended for an audience with a background in healthcare.

Reviews

“After struggling with debilitating nausea from gastroparesis for years, Reglan provided significant relief within a week. The ability to eat a full meal without immediate discomfort was life-changing. I am, however, acutely aware of the side effect risks and am under strict supervision with my gastroenterologist to monitor for any neurological signs.” – M.B., Patient

“Metoclopramide remains a valuable tool in our arsenal for severe, refractory gastroparesis. Its efficacy in promoting gastric emptying is well-documented. The paramount concern in clinical practice is vigilant patient selection, education on the risks of tardive dyskinesia, and strict adherence to short-term dosing protocols to mitigate potential harm.” – Dr. A. Sharma, Gastroenterologist