To celebrate both National Breastfeeding Month and Gastroparesis Awareness Month, we are presenting Metoclopramide. This drug is the only FDA-approved medication for gastroparesis. Besides being a prokinetic, it also increases prolactin, an important hormone for lactation that may offer good results. However, it carries an FDA Black Box Warning which limits the duration of use. Find out more about this drug:
Generic Name: Metoclopramide
Brand Name(s): Reglan, Metozolv ODT
Pronunciation: MET oh KLOE pra mide
About this drug:
Metoclopramide is used to treat the symptoms of slow stomach emptying in people with diabetes causing nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.
It is also used to treat heartburn, ulcers, and sores in the esophagus caused by gastroesophageal reflux disease (GERD).
Dentistry-related tidbits:
Metoclopramide may cause extrapyramidal symptoms such as tremors, restlessness, or jerky movements that may make the dental procedure more challenging.
This medication may cause drowsiness, confusion, muscle and balance problems. Remind the patient not to drive or engage in dangerous activities until they know how this medication affects them.
The sulfonamide antibiotic Sulfamethoxazole and local anesthetics (e.g. Articaine, Lidocaine) without Epinephrine may increase the risk of methemoglobinemia when combined with Metoclopramide.
Monitor blood pressure when administering local anesthetic with Epinephrine to a patient taking Metoclopramide, as this combination may increase or decrease blood pressure.
Do not prescribe anticonvulsants such as Carbamazepine or benzodiazepines such as Diazepam in combination with Metoclopramide as this may decrease seizure threshold.
Exercise caution when prescribing narcotics, muscle relaxants, or any other sedating medication in combination with this medication to avoid an increased risk of CNS and respiratory depression, severe hypotension, syncope, or diminished psychomotor function.
Caffeine, the oxazolidinone antibiotic Linezolid, steroids, and NSAIDs combined with Metoclopramide may increase the risk of hypertension. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Metoclopramide is a dopamine antagonist and enhances acetylcholine response in the upper gastrointestinal tract, causing increased motility, accelerated peristalsis and increases the resting tone of the lower esophageal sphincter.
This medication has an FDA Black Box Warning listing tardive dyskinesia, a serious, sometimes permanent movement problem. This risk increases the longer the medication is taken. Recommended treatment is not longer than 12 weeks. Patients should stop taking Metoclopramide if movement symptoms occur and contact their doctor immediately.
Elderly and diabetic patients, especially elderly women, have an increased risk of developing uncontrolled movements of the tongue, lips, face, and trunk, as well as tremors, age-related kidney problems, confusion, or drowsiness when taking this medication.
Metoclopramide was derived from the antiarrhythmic procainamide and was found to have gastrointestinal properties after modification in the chemical structure.
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