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 proven inadequate. As a dopamine receptor antagonist and prokinetic agent, it works by increasing the contractions of the upper gastrointestinal tract, accelerating gastric emptying, and strengthening the lower esophageal sphincter tone. This action provides targeted, symptomatic relief for conditions characterized by delayed gastric emptying and reflux, making it a valuable tool in a gastroenterologist’s arsenal when used appropriately under strict medical supervision.

Features

• Active Ingredient: Metoclopramide hydrochloride
• Available Forms: Tablets (5 mg, 10 mg), oral solution, and injectable formulation
• Mechanism of Action: Dopamine D2 receptor antagonist with prokinetic and antiemetic properties
• Onset of Action: Oral administration typically shows effects within 30-60 minutes
• Duration of Effect: Approximately 1-2 hours for symptomatic relief
• Bioavailability: 80% for oral tablets, with peak plasma concentrations reached in 1-2 hours
• Metabolism: Hepatic, primarily via oxidation
• Elimination Half-life: 5-6 hours in healthy adults
• Excretion: Primarily renal (approximately 85% of administered dose)

Benefits

• Accelerates gastric emptying and intestinal transit time in patients with gastroparesis
• Reduces symptoms of heartburn and regurgitation associated with GERD when other treatments fail
• Provides antiemetic effects by blocking dopamine receptors in the chemoreceptor trigger zone
• Enhances the coordination of antral and duodenal motor activity
• May improve glycemic control in diabetic patients by promoting more predictable nutrient absorption
• Facilitates small bowel intubation and radiologic examination of the GI tract

Common use

Reglan is primarily prescribed for the short-term (4-12 weeks) management of symptomatic diabetic gastroparesis in adults. It is also used for the relief of heartburn and regurgitation symptoms in patients with GERD who have not responded adequately to other therapies. Additionally, Reglan may be employed to prevent nausea and vomiting associated with chemotherapy, though other antiemetics are often preferred for this indication due to Reglan’s side effect profile. The medication is sometimes used off-label for postoperative nausea and vomiting and for facilitating small bowel intubation during diagnostic procedures.

Dosage and direction

For diabetic gastroparesis: The usual adult dosage is 10 mg taken 30 minutes before each meal and at bedtime for up to 12 weeks. Treatment duration should not exceed 12 weeks due to the increased risk of tardive dyskinesia with longer use.

For GERD: The recommended dose is 10-15 mg up to four times daily, 30 minutes before meals and at bedtime. Therapy should be limited to 4-12 weeks based on symptom response and tolerability.

For elderly patients or those with renal impairment: Dosage adjustment is necessary. For patients with creatinine clearance below 40 mL/min, the recommended dose is 5 mg with a reduced frequency as determined by the prescribing physician.

The tablets should be swallowed whole with water and may be taken with or without food, though administration before meals is preferred for optimal effect on gastric motility.

Precautions

Reglan should be used with caution in patients with depression, as it may exacerbate underlying depressive disorders. Patients with Parkinson’s disease may experience a worsening of symptoms due to dopamine receptor blockade. Hepatic impairment requires careful dosage consideration and potential reduction. Electrolyte abnormalities (particularly hypokalemia and hypomagnesemia) should be corrected before initiation, as they may increase the risk of arrhythmias. Patients should be monitored for signs of neuroleptic malignant syndrome, a rare but serious complication. Due to the risk of tardive dyskinesia, the lowest effective dose should be used for the shortest duration possible. Reglan may impair mental and physical abilities required for driving or operating machinery.

Contraindications

Reglan is contraindicated in patients with known hypersensitivity to metoclopramide or any components of the formulation. It should not be used in patients with gastrointestinal obstruction, perforation, or hemorrhage. Contraindications include pheochromocytoma due to the risk of hypertensive crisis, and epilepsy or seizure disorders as the drug may lower the seizure threshold. Concurrent use with other drugs that likely cause extrapyramidal reactions is contraindicated. The medication should not be administered to patients with a history of tardive dyskinesia.

Possible side effect

Common side effects (≥1%) include restlessness, drowsiness, fatigue, lethargy, insomnia, headache, dizziness, and nausea. Extrapyramidal symptoms such as acute dystonic reactions (spasms of neck muscles, rigidity, oculogyric crisis) may occur, particularly in pediatric and young adult patients. Other potential adverse reactions include galactorrhea, amenorrhea, gynecomastia, impotence, fluid retention, and rash. Tardive dyskinesia, characterized by involuntary movements of the face, tongue, or extremities, may develop and can become irreversible. Neuroleptic malignant syndrome, manifesting as hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability, represents a rare but serious complication.

Drug interaction

Reglan may accelerate the absorption of other orally administered drugs from the stomach, potentially increasing their bioavailability. Concurrent use with central nervous system depressants (alcohol, sedatives, opioids) may enhance sedative effects. The drug may antagonize the effects of levodopa and dopamine agonists. Caution is advised when administering with monoamine oxidase inhibitors due to theoretical risk of hypertensive crisis. Drugs that inhibit CYP2D6 metabolism may increase metoclopramide plasma concentrations. Anticholinergic medications may oppose the gastrointestinal effects of Reglan. Serotonergic drugs combined with metoclopramide may increase the risk of serotonin syndrome.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. If multiple doses are missed or uncertainty exists about proper dosing, patients should consult their healthcare provider for guidance.

Overdose

Symptoms of overdose may include drowsiness, disorientation, extrapyramidal reactions, seizures, and cardiovascular effects including bradycardia and hypotension. In severe cases, neuroleptic malignant syndrome may occur. Management involves supportive care and symptomatic treatment. Activated charcoal may be administered if ingestion was recent. Extrapyramidal symptoms may be treated with diphenhydramine, benztropine, or other anticholinergic agents. There is no specific antidote for metoclopramide overdose. Hemodialysis is not likely to be effective due to high protein binding and large volume of distribution.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F). Protect from light and moisture. Keep the medication in its original container, tightly closed. Do not store in bathroom areas where moisture levels may be higher. Keep all medications out of reach of children and pets. Properly discard any expired or unused medication according to local guidelines or through drug take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Reglan is a prescription medication that should be used only under the supervision of a qualified healthcare professional. The prescribing physician will determine the appropriate dosage and duration of therapy based on individual patient factors. Patients should not adjust their dosage or discontinue treatment without consulting their healthcare provider. The benefits and risks of therapy should be carefully considered, particularly regarding the potential for tardive dyskinesia with prolonged use.

Reviews

Clinical studies demonstrate that Reglan provides effective symptomatic relief in approximately 60-70% of patients with diabetic gastroparesis when used short-term. Many gastroenterologists report satisfactory results for refractory GERD symptoms, though most emphasize the importance of limiting treatment duration. Patient experiences vary significantly, with some reporting substantial improvement in nausea and early satiety, while others describe bothersome side effects, particularly drowsiness and restlessness. The medical community generally regards Reglan as a useful agent when employed judiciously for appropriate indications with careful patient monitoring and education about potential adverse effects.