NEODOSE

INDICATIONS

• facilitate gastric emptying and gastrointestinal motility: May improve feeding intolerance. Use in gastroesophageal reflux patients is controversial. (Also used to enhance lactation–10 mg every 8 hours.
• Apnea of prematurity: Reducing gastric acidity or increasing gastric motility for the sole purpose to reduce apnea episodes is not supported by the literature.

CONTRAINDICATIONS

• In patients when stimulation of gastrointestinal motility may be harmful (eg, presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation).
• In patients with pheochromocytoma (may cause a hypertensive crisis) r other catecholamine-releasing paragangliomas.
• In patients with epilepsy.
• In patients receiving other drugs that are likely to cause extrapyramidal reactions.
• In patients with a history of tardive dyskinesia or a dystonic reaction to metoclopramide (oral).

PRECAUTIONS:

• Cardiovascular :
  • Catecholamine release and elevated blood pressure may occur; avoid use in patients with hypertension or those taking monoamine oxidase inhibitors.
  • Fluid retention and volume overload may occur, especially in patients with cirrhosis or congestive heart failure; discontinue if such reactions occur.
• Endocrine & Metabolic :
  • Hyperprolactinemia may occur and lead to galactorrhea, amenorrhea, or gynecomastia.
• Neurologic:
  • Neuroleptic malignant syndrome (NMS) has been reported rarely; immediately discontinue use if occurs; avoid use in patients receiving other drugs associated with NMS, such as typical and atypical antipsychotics.
  • Acute dystonic reactions, which may present as stridor and dyspnea, have been reported and usually occur during first 24 to 48 hours of therapy; risk is increased pediatric patients and with higher doses used for prophylaxis of chemotherapy-related vomiting. Treatment of symptoms with diphenhydramine or benztropine may be required; avoid use in patients receiving other drugs likely to cause extrapyramidal symptoms
  • Tardive dyskinesia (TD), which may be irreversible, may occur; risk increased with duration of treatment and total cumulative dose; discontinue use if signs or symptoms develop; avoid use in patients receiving other drugs likely to cause TD.
  • Parkinsonian-like symptoms (bradykinesia, tremor, cogwheel rigidity, mask-like facies) have been reported within first 6 months of use; symptoms generally resolve following discontinuation; avoid use in patients with Parkinson disease and those being treated with antiparkinsonian drugs.
  • Akathisia (anxiety, agitation, jitteriness, insomnia, pacing, foot tapping) has occurred; if symptoms resolve, consider reinitiating at a lower dosage.
• Psychiatric:
  • Depression has been reported in patients with and without a history of depression; symptoms may range from mild to severe and include suicidal ideation and suicide; avoid use in patients with a history of depression.
  • Anxiety and restlessness, followed by drowsiness, may occur with too rapid administration.
• Surgery:
  • Additional pressure on suture lines following a gut anastomosis or closure may occur due to promotility activity.

ADVERSE EFFECTS

Intended for short-term use (several weeks). Dystonic reactions and extrapyramidal symptoms are seen frequently at higher doses and with prolonged use; children are more susceptible than adults.

BLACK BOX WARNING

Tardive Dyskinesia : Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose. Metoclopramide therapy should be discontinued in patients who develop signs or symptoms of tardive dyskinesia. There is no known treatment for tardive dyskinesia. In some patients, symptoms may lessen or resolve after metoclopramide treatment is stopped. Treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia

ADMINISTRATION

Intermittent IV infusion:

Dilute to 0.2 mg/mL in D5W or NS and infuse over a minimum of 15 minutes.

MONITORING

Measure gastric residuals. Observe for increased irritability or vomiting.