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 muscle contractions in the upper digestive tract, thereby accelerating gastric emptying and enhancing lower esophageal sphincter tone. This action facilitates the movement of food through the stomach and intestines, providing symptomatic relief from nausea, vomiting, heartburn, and feelings of prolonged fullness. Its use is supported by clinical guidelines for specific gastrointestinal motility disorders under careful medical supervision.

Features

• Active Ingredient: Metoclopramide hydrochloride
• Available Forms: Tablets (5 mg, 10 mg), oral solution, injectable solution
• Mechanism of Action: Dopamine D2 receptor antagonist; stimulates upper GI motility
• Onset of Action: Oral: 30–60 minutes; IV: 1–3 minutes
• Duration of Effect: 1–2 hours
• Half-life: Approximately 5–6 hours
• Metabolism: Hepatic, via CYP2D6
• Excretion: Renal (approximately 85%)

Benefits

• Accelerates gastric emptying and intestinal transit, reducing symptoms of delayed digestion
• Provides effective relief from nausea and vomiting associated with gastroparesis
• Decreases symptoms of gastroesophageal reflux, including heartburn and regurgitation
• May be used as an adjunct to facilitate small bowel intubation and radiologic examinations
• Can provide symptomatic improvement where other antiemetics or prokinetics have failed
• Available in multiple formulations for flexible administration based on clinical need

Common use

Reglan is commonly prescribed for the short-term management (4–12 weeks) of symptomatic diabetic gastroparesis, a condition characterized by delayed gastric emptying that causes nausea, vomiting, early satiety, and postprandial fullness. It is also used for the treatment of gastroesophageal reflux disease in patients who have not responded adequately to other therapies. Off-label uses may include prevention of postoperative nausea and vomiting, chemotherapy-induced nausea and vomiting (though other agents are often preferred), and as an adjunct in facilitating small bowel intubation during radiographic procedures. Treatment duration is typically limited due to the risk of tardive dyskinesia with prolonged use.

Dosage and direction

For diabetic gastroparesis in adults: 10 mg orally, 30 minutes before each meal and at bedtime, for 2–8 weeks. The duration of therapy should not exceed 12 weeks due to increased risk of adverse effects. For GERD: 10–15 mg orally up to four times daily, 30 minutes before meals and at bedtime. Injectable forms are administered intravenously or intramuscularly for acute situations under medical supervision. Dosage must be adjusted in patients with renal impairment (CrCl <40 mL/min) and in those who are poor CYP2D6 metabolizers. Administration should be with a full glass of water. Do not crush or chew tablets.

Precautions

Use with caution in patients with depression, Parkinson’s disease, or hypertension. May cause drowsiness or dizziness; patients should avoid driving or operating machinery until they know how Reglan affects them. Alcohol and CNS depressants may enhance sedative effects. Not recommended for use in children except in specific endoscopic or radiologic procedures. Elderly patients are at increased risk for adverse effects, including extrapyramidal symptoms and tardive dyskinesia. Periodic reassessment of the need for continued therapy is essential. Patients should be monitored for signs of neuroleptic malignant syndrome (hyperthermia, muscle rigidity, autonomic instability).

Contraindications

Hypersensitivity to metoclopramide or any component of the formulation; history of tardive dyskinesia; pheochromocytoma; gastrointestinal obstruction, perforation, or hemorrhage; epilepsy (may lower seizure threshold). Concomitant use with drugs that may cause extrapyramidal symptoms is contraindicated. Should not be used when stimulation of gastrointestinal motility might be dangerous. Avoid in patients with known CYP2D6 poor metabolizer status due to increased drug exposure and risk of adverse events.

Possible side effect

Common: restlessness, drowsiness, fatigue, diarrhea. Less common: extrapyramidal symptoms (dystonia, akathisia, Parkinson-like symptoms), galactorrhea, menstrual disturbances. Serious: tardive dyskinesia (often irreversible), neuroleptic malignant syndrome, depression, suicidal ideation, hyperprolactinemia. Cardiovascular effects may include hypotension, hypertension, supraventricular tachycardia. Allergic reactions including rash and urticaria may occur. Report any involuntary movements, especially of the face or tongue, immediately to a healthcare provider.

Drug interaction

May enhance effects of CNS depressants (alcohol, sedatives, opioids). Serotonergic drugs (SSRIs, SNRIs) may increase risk of serotonin syndrome. Anticholinergic drugs may antagonize the effects of Reglan. CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) may increase metoclopramide levels. May affect absorption of other drugs due to altered gastrointestinal motility. Use caution with drugs that prolong QT interval. Avoid concomitant use with antipsychotics and other dopamine antagonists.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. Maintain the regular dosing schedule. If multiple doses are missed, consult a healthcare provider for guidance on resuming therapy.

Overdose

Symptoms may include drowsiness, disorientation, extrapyramidal reactions, seizures, and cardiovascular instability. In case of suspected overdose, seek immediate medical attention. Treatment is supportive and may include activated charcoal if ingested recently, benzodiazepines for agitation or seizures, and antiparkinsonian drugs for extrapyramidal symptoms. Dialysis is not likely to be effective due to high protein binding.

Storage

Store at room temperature (20–25°C or 68–77°F), away from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Oral solution should not be frozen. Discard any unused medication properly according to local guidelines; do not flush down the toilet or pour into drainage.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should evaluate individual patient factors, including medical history, current medications, and potential risks versus benefits. Treatment should be tailored to the patient’s specific condition under appropriate medical supervision.

Reviews

Clinical studies and patient reports indicate that Reglan can be highly effective for symptomatic relief of gastroparesis and refractory GERD when used appropriately for short durations. Many patients experience significant improvement in nausea, vomiting, and gastric discomfort. However, concerns regarding neurological side effects, particularly tardive dyskinesia, emphasize the importance of limiting treatment duration and monitoring patients closely. Healthcare providers generally reserve its use for cases where other therapies have failed and weigh potential benefits against risks. Patient experiences vary, with some reporting rapid symptom relief and others discontinuing due to side effects such as restlessness or fatigue.