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 therapies have proven inadequate. As a prokinetic agent, it works by enhancing the motility of the upper gastrointestinal tract, accelerating gastric emptying, and strengthening the lower esophageal sphincter tone. Its targeted mechanism offers a clinically validated approach for managing these challenging gastrointestinal disorders, providing symptomatic relief and improving quality of life for appropriate patients under strict medical supervision.

Features

• Active Ingredient: Metoclopramide hydrochloride
• Available Forms: Tablets (5 mg, 10 mg), oral solution (5 mg/5 mL), injectable solution (5 mg/mL)
• Pharmacologic Class: Dopamine D2 receptor antagonist; prokinetic agent
• 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 oxidative metabolism
• Excretion: Primarily renal (approximately 85%)

Benefits

• Accelerates gastric emptying and intestinal transit, reducing nausea, vomiting, and early satiety in gastroparesis
• Increases lower esophageal sphincter pressure, decreasing reflux episodes and heartburn severity in refractory GERD
• Provides rapid symptomatic relief, often within one hour of administration
• Facilitates small bowel intubation and radiographic examination by improving GI motility
• May prevent nausea and vomiting associated with chemotherapy or postoperative recovery (off-label use in specific scenarios)
• Offers multiple administration routes (oral, IV) for flexible clinical use

Common use

Reglan is primarily prescribed for two main indications. First, for the short-term treatment (4 to 12 weeks) of symptomatic diabetic gastroparesis in adults, helping alleviate nausea, vomiting, persistent fullness after meals, and bloating. Second, as therapy for severe, refractory gastroesophageal reflux disease that has not responded adequately to other treatments like proton pump inhibitors or H2 blockers. Off-label uses may include prevention of postoperative nausea and vomiting, and as an antiemetic in certain chemotherapy regimens, though these applications require careful risk-benefit assessment due to the drug’s side effect profile.

Dosage and direction

For diabetic gastroparesis in adults: 10 mg orally (tablet or solution) 30 minutes before each meal and at bedtime for up to 12 weeks. The duration should be limited to the shortest period possible based on symptom response.

For GERD: 10-15 mg orally up to four times daily 30 minutes before meals and at bedtime. Therapy should not exceed 12 weeks.

For facilitating small bowel intubation: A single IV dose of 10 mg administered over 1-2 minutes.

Dosage must be individualized based on clinical response and tolerability. Renal impairment requires dosage adjustment: For CrCl <40 mL/min, reduce dose by 50%. Not recommended in severe hepatic impairment. Tablets should be swallowed whole with water; the oral solution should be measured precisely using the provided dosing syringe.

Precautions

Reglan carries a Boxed Warning regarding the risk of tardive dyskinesia, which may be irreversible. Treatment should not exceed 12 weeks. Elderly patients, particularly elderly women, and those with diabetes may be at greater risk. Monitor for extrapyramidal symptoms (EPS), particularly in pediatric patients. May cause drowsiness or impair mental/physical abilities required for hazardous tasks. Use with caution in patients with depression, Parkinson’s disease, hypertension, or cardiac conduction abnormalities. Periodic reevaluation of continued therapy is essential. Pregnancy Category B: use only if clearly needed. Excreted in breast milk; caution advised during breastfeeding.

Contraindications

Hypersensitivity to metoclopramide or any component of the formulation. Concomitant use with drugs likely to cause extrapyramidal reactions. History of gastrointestinal obstruction, perforation, or hemorrhage. Pheochromocytoma due to risk of hypertensive crisis. Epilepsy or seizure disorders (may lower seizure threshold). History of methemoglobinemia with metoclopramide or NADH cytochrome b5 reductase deficiency.

Possible side effect

Common (≥1%): Restlessness, drowsiness, fatigue, headache, insomnia, nausea, diarrhea. Less common: Extrapyramidal symptoms (dystonia, akathisia, parkinsonism), galactorrhea, menstrual irregularities, hyperprolactinemia. Serious: Tardive dyskinesia (potentially irreversible), neuroleptic malignant syndrome, depression, suicidal ideation, methemoglobinemia, seizures, cardiac conduction abnormalities. Most side effects are dose-related and more frequent with prolonged use.

Drug interaction

Strong CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) may increase metoclopramide levels. May enhance effects of CNS depressants (alcohol, sedatives, opioids). Anticholinergic drugs may antagonize gastrointestinal effects. May affect absorption of other drugs by altering gastrointestinal motility. Serotonergic drugs may increase risk of serotonin syndrome. Contraindicated with drugs that may cause extrapyramidal symptoms. May interfere with therapeutic response to levodopa and dopamine agonists.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule before meals and at bedtime as prescribed. If multiple doses are missed, contact healthcare provider for guidance.

Overdose

Symptoms may include drowsiness, confusion, extrapyramidal reactions, seizures, cardiac conduction abnormalities, and methemoglobinemia. Management is supportive and symptomatic. There is no specific antidote. Extrapyramidal reactions may be treated with diphenhydramine, benztropine, or diazepam. Severe cases may require hospitalization. Hemodialysis is not likely to be effective due to high protein binding.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep the oral solution in the original container. Keep all medications out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not freeze. For institutional use, follow facility protocols for narcotic and controlled substance storage if applicable.

Disclaimer

This information is 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. Individual response to medication may vary. Always follow your healthcare provider’s instructions regarding dosage, administration, and duration of treatment. Report any side effects to your healthcare provider promptly. The full prescribing information contains additional important safety information.

Reviews

“After struggling with diabetic gastroparesis for years, Reglan provided significant relief from my constant nausea and vomiting. The improvement in my quality of life was noticeable within the first week of treatment, though I did experience some drowsiness initially.” — M.B., 54

“As a gastroenterologist, I find Reglan invaluable for short-term management of refractory gastroparesis cases. While I strictly limit treatment duration due to the TD risk, the symptomatic relief it provides selected patients is often dramatic and clinically meaningful when used appropriately.” — Dr. R.S., MD

“The effectiveness for my severe GERD was remarkable when other medications failed, but the restlessness and muscle spasms I experienced required discontinuation. Careful monitoring is essential with this medication.” — T.K., 42