Metoclopramide

INTRODUCTION

Indications

Prevention of chemotherapy-induced emesis. Treatment of postsurgical and diabetic gastric stasis. Facilitation of small bowel intubation in radiographic procedures. Management of esophageal reflux. Treatment and prevention of postoperative nausea and vomiting when nasogastric suctioning is undesirable. Unlabeled Use: Treatment of hiccups. Adjunct management of migraine headaches.

Action

Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying. Therapeutic Effects: Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Easier passage of nasogastric tube into small bowel.

Adverse Reactions/Side Effects

CNS: drowsiness, extrapyramidal reactions, restlessness, NEUROLEPTIC MALIGNANT SYNDROME, anxiety, depression, irritability, tardive dyskinesia. CV: arrhythmias (supraventricular tachycardia, bradycardia), hypertension, hypotension. GI: constipation, diarrhea, dry mouth, nausea. Endo: gynecomastia. Hemat: methemoglobinemia, neutropenia, leukopenia, agranulocytosis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician or nursing staff immediately.

• Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • ∘ Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).

  • ∘ Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).

  • ∘ Akathisia (restlessness or desire to keep moving).

  • ∘ Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

• Monitor the frequency, severity, and duration of GI problems (nausea, vomiting, heartburn, hiccups) to help document drug effectiveness.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any disturbances in cardiac rhythm or symptoms of arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess BP and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Monitor signs of agranulocytosis, neutropenia, and leukopenia (fever, sore throat, signs of infection) or methemoglobinemia (bluish coloring of the skin, lips fingernails; headache; shortness of breath; lack of energy). Report these signs to the physician or nursing staff.

• If used to treat migraines, assess the frequency and severity of headaches and document whether drug therapy is successful in decreasing migraine attacks.

Interventions