Maxocol Tablet

Introduction

Metoclopramide hydrochloride is a medication primarily used to treat gastrointestinal disorders. It acts as an antiemetic and prokinetic agent, helping to alleviate nausea, vomiting, and gastric emptying issues. It is commonly used in conditions where improved gastric motility is desired.

Uses

Metoclopramide hydrochloride is used for:

Nausea and Vomiting: Effective in treating nausea and vomiting associated with chemotherapy, radiation therapy, and postoperative conditions.
Gastroparesis: Used to improve gastric emptying in patients with diabetic gastroparesis and other motility disorders.
GERD: Helps alleviate symptoms of gastroesophageal reflux disease (GERD) by enhancing esophageal motility and preventing acid reflux.
Postoperative Nausea: Prevents and treats nausea and vomiting following surgical procedures.

Brand Name	Maxocol
Type	Tablet
Weight	10 mg
Generic	Metoclopramide Hydrochloride
Manufacturer	Medimet Pharmaceuticals Ltd.
Available in	English বাংলা

Mechanism of Action

Metoclopramide hydrochloride works through:

Dopamine Receptor Antagonism: It blocks dopamine receptors in the central nervous system, which helps to reduce nausea and vomiting.
Prokinetic Effect: It enhances gastrointestinal motility by increasing the tone and motility of the gastrointestinal tract, facilitating gastric emptying.
Antiemetic Action: By affecting the chemoreceptor trigger zone (CTZ) in the brain, it helps to prevent and reduce nausea and vomiting.

How Long Does It Take to Work?

Metoclopramide hydrochloride typically starts to work within 30 to 60 minutes after oral administration, with peak effects occurring within 1 to 2 hours. For intravenous administration, onset of action is usually within minutes.

Absorption

Metoclopramide hydrochloride is well-absorbed from the gastrointestinal tract. The oral bioavailability is approximately 80%, with peak plasma concentrations occurring within 1 to 2 hours after administration.

Route of Elimination

Metoclopramide is primarily metabolized in the liver, with a significant amount of the drug being excreted unchanged in the urine. The renal excretion of the drug accounts for approximately 60% of the administered dose.

Dosage

Metoclopramide Spray:

Adults less than 65 years of age: The recommended dosage is 1 spray (15 mg) in one nostril, 30 minutes before each meal and at bedtime (maximum of 4 sprays daily) for 2 to 8 weeks, depending on symptomatic response.

Adults 65 years of age and older: Metoclopramide is not recommended in geriatric patients as initial therapy. Geriatric patients receiving an alternative metoclopramide product at a stable dosage of 10 mg four times daily can be switched to Metoclopramide 1 spray (15 mg) in one nostril, 30 minutes before each meal and at bedtime (maximum four times daily) for 2 to 8 weeks, depending on symptomatic response.

Metoclopramide tablet:

Gastroesophageal Reflux: Administer Metoclopramide continuously or intermittently:

Continuous: Administer 10 to 15 mg, 30 minutes before each meal and at bedtime (maximum of 60 mg per day) for 4 to 12 weeks.
Intermittent: Single doses up to 20 mg prior to provoking situation.

Acute and Recurrent Diabetic Gastroparesis: Administer 10 mg, 30 minutes before each meal and at bedtime (maximum of 40 mg per day) for 2 to 8 weeks.

Metoclopramide injection:

For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis): If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated. However, if severe symptoms are present, therapy should begin with Metoclopramide Injection (IM or IV). Doses of 10 mg may be administered slowly by the intravenous route over a 1- to 2-minute period. Administration of Metoclopramide Injection (metoclopramide injection, USP) up to 10 days may be required before symptoms subside, at which time oral administration of metoclopramide may be instituted. The physician should make a thorough assessment of the risks and benefits prior to prescribing further metoclopramide treatment.

For the Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy: Intravenous infusions should be made slowly over a period of not less than 15 minutes, 30 minutes before beginning cancer chemotherapy and repeated every 2 hours for two doses, then every 3 hours for three doses. The initial two doses should be 2 mg/kg if highly emetogenic drugs such as cisplatin or dacarbazine are used alone or in combination. For less emetogenic regimens, 1 mg/kg per dose may be adequate.

For the Prevention of Postoperative Nausea and Vomiting: Metoclopramide Injection should be given intramuscularly near the end of surgery. The usual adult dose is 10 mg; however, doses of 20 mg may be used.

Dosage depends on the condition being treated:

Adults: For nausea and vomiting, the typical oral dose is 10 to 15 mg every 4 to 6 hours as needed, not exceeding 60 mg/day. For gastroparesis, the usual dose is 10 mg 3 to 4 times daily before meals and at bedtime.
Children: Dosage should be adjusted based on weight and specific medical condition, generally starting at 0.1 mg/kg to 0.15 mg/kg administered 3 to 4 times daily.
Intravenous Administration: 10 mg to 20 mg, administered slowly over 1 to 2 minutes, especially for immediate relief of nausea and vomiting.

Administration

Oral: Tablets or liquid form taken by mouth.
Intravenous: Administered slowly by injection into a vein, typically in a hospital or clinical setting.
Intramuscular: Injection into a muscle for certain cases where oral or intravenous administration is not feasible.

Side Effects

Common side effects include:

Drowsiness
Dizziness
Fatigue
Diarrhea
Headache

Serious side effects can include extrapyramidal symptoms (e.g., tremors, rigidity), tardive dyskinesia, and severe allergic reactions. Seek medical attention if severe symptoms occur.

Toxicity

Symptoms of overdose may include severe drowsiness, agitation, and extrapyramidal symptoms such as muscle stiffness or tremors. Treatment focuses on symptomatic relief and discontinuation of the medication.

Precautions

Use with caution in patients with a history of seizure disorders or who are at risk for seizures.
Monitor for signs of tardive dyskinesia, especially with long-term use.
Adjust dosage in patients with renal or hepatic impairment to prevent toxicity.

Interaction

May interact with other central nervous system depressants, increasing the risk of drowsiness and sedation.
Anticholinergic drugs may reduce the effectiveness of metoclopramide.

Disease Interaction

Use cautiously in patients with gastrointestinal obstruction, perforation, or bleeding.
Patients with Parkinson's disease or other movement disorders should be monitored closely for worsening symptoms.

Drug Interaction

May interact with drugs that affect gastrointestinal motility, such as antacids, which can impact its effectiveness.
Antidepressants, antipsychotics, and other medications with similar side effects may exacerbate central nervous system effects.

Food Interactions

Food does not significantly affect the absorption of metoclopramide. However, taking it with food may help reduce gastrointestinal side effects.

Pregnancy Use

Metoclopramide is classified as a Category B drug for pregnancy, indicating that it is generally considered safe but should only be used if the benefits outweigh the risks. Consult a healthcare provider before use during pregnancy.

Lactation Use

Metoclopramide is excreted in breast milk in small amounts. It is generally considered safe for use during lactation, but the potential effects on the infant should be monitored. Consult a healthcare provider for guidance.

Acute Overdose

In case of acute overdose, symptoms may include severe drowsiness, agitation, and extrapyramidal symptoms. Treatment involves discontinuation of the drug and supportive care, including monitoring and symptomatic management.

Contraindication

Contraindicated in patients with a known hypersensitivity to metoclopramide or any component of the formulation.
Not recommended in individuals with a history of extrapyramidal symptoms or tardive dyskinesia.
Should not be used in patients with gastrointestinal obstruction, perforation, or bleeding.

Use Direction

Follow prescribed dosage and administration instructions precisely.
Monitor for side effects and report any severe symptoms to a healthcare provider.

Storage Conditions

Store at room temperature, away from moisture and heat.
Keep out of reach of children and dispose of any unused medication properly.

Volume of Distribution

The volume of distribution for metoclopramide is approximately 4 to 6 L/kg, indicating its distribution into body tissues.

Half Life

The half-life of metoclopramide is approximately 5 to 6 hours in healthy individuals. It may be prolonged in patients with renal impairment or those on long-term therapy.

Clearance

Metoclopramide is primarily cleared through the kidneys. The clearance rate may be reduced in patients with renal impairment, necessitating dosage adjustments.

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