MetoclopramideMetoclopramide Hydrochloride

About Metoclopramide

Metoclopramide blocks dopamine D2 receptors and strengthens stomach contractions so food moves on faster. Taken by mouth, it is approved only for adults: to relieve the symptoms of diabetic gastroparesis and, for 4 to 12 weeks, reflux that has not responded to conventional therapy.

The boxed warning is for tardive dyskinesia, involuntary movements such as lip smacking, chewing, frowning, tongue thrusting and blinking that can be permanent. The risk rises with treatment length and total dose and is higher in older adults, especially women, and in diabetes. Reflux treatment is limited to 12 weeks, and the label advises against more than 12 weeks in total for gastroparesis. If they appear, the label says to stop it and contact the prescriber at once.

Restlessness, drowsiness and tiredness are common. Other risks include muscle spasms, Parkinson-like symptoms, depression with suicidal thoughts, neuroleptic malignant syndrome (fever with rigid muscles), raised blood pressure, fluid retention and raised prolactin. It must not be used with a blocked, bleeding or perforated gut, epilepsy, a pheochromocytoma, past tardive dyskinesia or a past dystonic reaction to metoclopramide.

Doses are lower in older adults, in moderate to severe kidney or liver impairment, in slow CYP2D6 metabolizers and with fluoxetine, paroxetine, bupropion or quinidine. Gimoti, for diabetic gastroparesis, is not recommended in those kidney, liver or CYP2D6 situations, nor as a first treatment at 65 or older; an altered taste is its most common side effect.

Taking Metoclopramide

How to take it

Usually 30 minutes before each meal and at bedtime. Put the dissolving tablet on the tongue with dry hands; it dissolves in about a minute and is swallowed without water. Prime a new Gimoti bottle with 10 sprays into the air, then use one spray in one nostril.

If you miss a dose

Tablets and liquid: take it when you remember unless the next dose is near, then skip it. Gimoti: skip the missed dose. Never take a double dose.

Storage

At room temperature, tightly closed, out of reach of children. Discard Gimoti 4 weeks after opening, even if not empty.

Interactions to know about

Antipsychotics, levodopa, apomorphine and MAO inhibitors are avoided with it. Fluoxetine, paroxetine, bupropion and quinidine raise its levels. Alcohol and sedatives add to drowsiness. It lowers digoxin absorption and raises absorption of tacrolimus, cyclosporine and sirolimus. Faster stomach emptying can change blood sugar after meals, so insulin may need adjusting.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Metoclopramide differs from pharmacy to pharmacy

Plain tablets have many makers and cost pharmacies very little, so the price is mostly fee and markup. With up to four doses a day, a course is a lot of tablets, and a pharmacy that charges per tablet can quote far more.

The dissolving tablet and liquid have few makers, so quotes vary more; since the Metozolv ODT brand is discontinued, every dissolving tablet dispensed is a generic, and a pharmacy that does not stock it may need to order it in. Brand-only Gimoti cannot be swapped for tablets without a new prescription.

Ways to pay less for Metoclopramide without insurance

• Ask whether metoclopramide tablets are on the pharmacy’s flat-price generic list.
• If the dissolving tablet or liquid was chosen for convenience, ask whether plain tablets would suit you.
• If Gimoti is prescribed, ask whether an oral form would do, and ask its maker about patient assistance.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Metoclopramide

1. 1.Which movements or mood changes mean I should stop and call?
2. 2.How long should I take it?
3. 3.Does it interact with my antidepressant, antipsychotic or Parkinson’s medicine?
4. 4.Should I check my blood sugar more often?
5. 5.Is it safe to drive or drink alcohol?

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